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661 Training & Testing

Ruchat S-M et al. Walking Program of Low … Int J Sports Med 2012; 33: 661–666

accepted after revision
January 31 , 2012
Bibliography
DOI http://dx.doi.org/
10.1055/s-0032-1304635
Published online:
April 17, 2012
Int J Sports Med 2012; 33:
661–666 © Georg Thieme
Verlag KG Stuttgart · New York
ISSN 0172-4622
Correspondence
Dr. Stephanie-May Ruchat
The University of Western
Ontario
Kinesiology
3M Centre
room 2245
London
Canada N6A 3K7
Tel.: +1/519/661 2111
Extn.: 88366
Fax: +1/519/661 2008
sruchat@uwo.ca
Key words


pregnancy


walking program


exercise intensity


nutritional control


cardiorespiratory responses
Walking Program of Low or Vigorous Intensity During
Pregnancy Confers an Aerobic Benefit
Research over the past 25 years has demonstrated
that healthy women with low-risk pregnancies
can safely participate in aerobic exercise without
affecting fetal growth and development [ 7 , 15 ,
32 , 35 ] . In fact, prenatal exercise has been identi-
fied as an important component of a healthy
pregnancy and is beneficial to the mother and
fetus [ 30 ] . All categories of physical activities
were shown to decrease during pregnancy, except
walking, which increased in the 3
rd
trimester
[ 18 ] , suggesting that walking is an important aer-
obic activity for pregnant women. In addition,
adequate dietary intake during pregnancy is
highly important so that the women meet nutri-
tional and weight gain recommendations of preg-
nancy [ 11 ] . Implementation of a weight-bearing
exercise regime during pregnancy, combined
with nutritional control, may therefore confer
progressive benefits due to the healthy weight-
gain associated with increasing gestation [ 20 ] .
Introduction

Pregnancy is characterized by significant anatomic
and cardiorespiratory changes, mediated by gesta-
tional hormones initiated early in the first trimes-
ter, that accommodate the needs of the fetus and
the mother [ 29 ] . Pregnancy-induced cardiorespira-
tory alterations are well defined [ 5 , 13 , 26 , 29 ] .
These include an increase in oxygen uptake (VO
2
)
due to the metabolic demands of the uteroplacen-
tal unit, as well as the increased maternal body
mass, increases in heart rate (HR), stroke volume
and cardiac output, due to increased heart size and
blood volume, increases in minute ventilation (V
E
)
and tidal volume (V
T
), with little or no changes in
respiratory frequency (f
R
), due, at least in part, to
progesterone-induced increases in the sensitivity
to carbon dioxide (CO
2
). It is well documented that
these changes also have an important influence on
the responses to exercise [ 15 , 17 , 21 , 35 , 37 ] .
Authors S.-M. Ruchat
1
, M. H. Davenport
1
, I. Giroux
2
, M. Hillier
1
, A. Batada
1
, M. M. Sopper
1
, J.-A. Hammond
3
, M. Mottola
1

,

4

,

5

Affi liations
1
Kinesiology, The University of Western Ontario, London, Canada

2
Food and Nutritional Sciences, Brescia University College, London, Canada

3
Family Medicine, Schulich School of Medicine, The University of Western Ontario, London, Canada

4
Anatomy and Cell Biology, The University of Western Ontario, London, Canada

5
Children’s Health Research Institute, The University of Western Ontario, London, Canada
Abstract

Walking is the most popular activity during
pregnancy and may confer an aerobic benefit.
However, the minimum intensity threshold of a
maternal walking program for an aerobic condi-
tioning response is unknown. The purpose was
to examine the effect of a walking program of a
low-intensity (LI, 30 % heart rate reserve, HRR)
or vigorous-intensity (VI, 70 %HRR) on maternal
cardiorespiratory responses to a standard sub-
maximal treadmill test. Normal weight pregnant
women were randomized at study entry (16–20
weeks of gestation) to the LI (n = 23) or VI (n = 21)
walking program, with nutritional control. Par-
ticipants performed a steady-state treadmill
exercise test at their prescribed intensity pre-
and post-intervention (34–36 weeks) to evaluate
changes in cardiorespiratory responses. Increas-
ing body mass due to pregnancy was si milar
between the groups throughout the study.
From pre- to post-intervention, relative (mL
kg
− 1
min
− 1
) VO
2
and VCO
2
during steady-state
submaximal treadmill exercise did not change
in the LI group but decreased in the VI group
(− 1.25 ± 2.71, p = 0.02 and − 1.50 ± 2.64, p = 0.005,
respectively). Both groups presented increases
in oxygen pulse (p ≤ 0.002). Our results showed
that the energy cost of walking was not affected
by the increase in maternal body weight in the
LI group and was decreased in the VI group,
suggesting an aerobic conditioning response in
both groups, although the VI group presented
a greater response. All women presented simi-
lar body mass throughout the intervention and
delivered healthy babies, indicating that a prena-
tal walking program of low or vigorous intensity,
combined with healthy eating habits, is safe and
beneficial to the mother and fetus.
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662 Training & Testing
Ruchat S-M et al. Walking Program of Low … Int J Sports Med 2012; 33: 661–666
Thus, intervention studies are needed to evaluate how a walking
program, combined with nutritional control, may alter the nor-
mal pregnancy-induced changes in cardiorespiratory responses
to exercise. Furthermore, the minimum intensity threshold of a
walking program to achieve any potential adaptations is
unknown for pregnant women and should be determined. In a
non-pregnant population, 30 % VO
2
reserve was a minimal effec-
tive training intensity for lower fit subjects [ 28 ] . Similarly, the
American College of Sports Medicine (ACSM) suggests that the
minimum intensity of a prenatal exercise program necessary to
achieve an aerobic benefit in previously sedentary women is
equivalent to 20–39 % VO
2
reserve [ 1 ] , which corresponds to
approximately 13–33 % heart rate reserve (HRR) [ 6 ] . We therefore
chose 30 % HRR (low intensity-LI) to correspond to the minimum
intensity needed to produce an aerobic training effect for a walk-
ing program in our pregnant population and 70 % HRR (vigorous
intensity-VI) to correspond to the intensity recommended in the
Canadian guidelines for exercise in healthy pregnancy [ 33 ] .
The objective of the present study was to evaluate the effects of
a supervised LI vs. VI walking program, combined with nutri-
tional control, on maternal cardiorespiratory responses to a
standardized submaximal steady-state treadmill exercise test in
normal weight women. We hypothesized that women rand-
omized to the VI group would achieve greater improvement in
submaximal aerobic capacity during standard treadmill exercise
in late pregnancy compared to those randomized to the LI group.
Materials and Methods

The study has been performed in accordance with the ethical
standards of IJSM [ 10 ] .
Participants
Seventy-two normal weight pregnant women (pre-pregnancy
body mass index (BMI) of 18.5–24.9 kg/m
2
; [ 31 ] ) between 16–20
weeks gestation were recruited through referrals from their
medical professionals, posters and advertisements in newspa-
pers in London, Ontario, Canada. Before being enrolled in the
study, women were medically pre-screened (PARmed-X for
Pregnancy; [ 34 ] by their health care provider. Specific exclusion
criteria included the following: maternal age greater than 40
years, smoking, multiple pregnancy, presence of chronic dis-
eases, or other contra-indications to exercise [ 34 ] . Ethics
approval was obtained from the Human Research Ethics Board
for Health Sciences at The University of Western Ontario and
written informed consent was obtained from participants.
Protocol to determine exercise intensity in the groups
After medical prescreening, at 16–20 weeks of gestation, women
completed a peak exercise test to volitional fatigue on a tread-
mill (Precor
TM
C942) as previously described [ 19 ] . 1 h prior to
the peak test, all participants consumed a standard meal (one
pouch (38-g serving) of Carnation Instant Breakfast
TM
mixed
with 250 mL of 2 % milk; 248 kcal (1 037 kJ), 14.2 g of protein,
3.8 g of fat and 39.3 g of carbohydrate) to ensure that results
were not altered by variation in dietary intake. In addition,
women avoided caffeine and exercise 12 h prior to testing. Room
temperature was maintained at 20 ± 2 °C with 55 % humidity.
Prior to the peak test, the SensorMedics (Yorba Linda, CA, USA)
VO
2
max 29c breath-by breath gas-analysis unit was calibrated
according to the company instructions. The flow sensor meter
was calibrated to a 3-L syringe (SensorMedics, Yorba Linda, CA,
USA). The acceptable range for calibration was within ± 2 % vari-
ability. During the peak exercise test, the participants were
required to breathe through a mouthpiece and end-tidal gases
and respiratory flow rates were sampled using the SensorMedics
VO
2
max 29c gas-analysis unit (SensorMedics, Yorba Linda, CA,
USA). Oxygen consumption and ventilation were computed in
real time on a breath-by-breath basis (SensorMedics, Yorba
Linda, CA, USA). Data were stored offl ine for further analysis. HR
was recorded using a 4 lead ECG (SensorMedics, Yorba Linda, CA,
USA). Peak test cardiorespiratory values were determined from
the average of the last 30 s preceding volitional fatigue [ 19 ] .
After the completion of the peak test, each woman was rando-
mized using a randomized/block procedure with 4 participants
per block into either the LI (30 % HRR) or VI (70 % HRR) group,
each with similarly controlled dietary intake. Based on the peak
test results, specific target HR zones, corresponding to 30 % HRR
or 70 % HRR, were determined for prescription of exercise.
Protocol to determine cardiorespiratory responses to
exercise
At least 48 h after the peak exercise test (16–20 weeks of gesta-
tion), and at least 48 h after the last exercise session of the exer-
cise program (34–36 weeks of gestation), all participants
performed a 20-min steady-state exercise test (i. e., an exercise
test at a constant work rate for 20 min) on a treadmill at their
prescribed exercise intensity according to the group to which
they were randomized. Steady-state physiological cardiorespira-
tory parameters were defined from the SensorMedics VO2max
29c gas-analysis unit (SensorMedics, Yorba Linda, CA, USA), as
less than 10 % variation in VO2, VE and HR during the last 2 min
of the steady-state exercise. 1 h prior to the test, all participants
consumed the same standard meal as before the peak test.
Before the steady-state test, pre-exercise data were collected for
5 min with the woman standing quietly on the treadmill. This
was followed by a 5-min warm-up, which started at 4.8 km/h
with no incline and was ramped up over the 5-min warm-up to
the speed and incline corresponding to 30 % HRR or 70 % HRR,
based on the results of the peak exercise test. The women con-
tinued for an additional 20 min (steady-state) at their prescribed
exercise intensity. The speed and incline was the same during
the pre- and post steady-state exercise bout, which corre-
sponded to 4.8 km/h, 1.4 % grade (0–4 % grade, min-max) for the
LI group and to 5.3 km/h (4.8–6.4 km/h, min-max), 10.5 % grade
(4–12 % grade, min-max) for the VI group. The participants
ended the steady-state exercise bout with a 5-min cool-down
(4.8 km/h, 0 % grade) and subsequently stood for 5 min (recov-
ery).
Oxygen consumption and ventilation were computed in real time
on a breath-by-breath basis and HR was recorded throughout the
test using a 4 lead ECG (SensorMedics, Yorba Linda, CA, USA). Pre-
exercise cardiorespiratory values were calculated as a 1 min aver-
age immediately preceding the 5-min warm-up. Variables
examined pre-exercise included: HR (bpm), absolute oxygen con-
sumption (VO
2
, L min
− 1
) and carbon dioxide production (VCO
2
,
L min
− 1
), and minute ventilation (V
E
, L min
− 1
). Similarly, exercise
values were calculated as a 1 min average during the 18
th
min of
the steady-state exercise bout. During exercise, we examined HR
(bpm), absolute and relative oxygen consumption (VO
2
, L min
− 1

and mL kg
− 1
min
− 1
, respectively) and carbon di oxide production
(VCO
2
, L min
− 1
and mL kg
− 1
min
− 1
, respectively), minute ventila-
tion (V
E
, L min
− 1
) and oxygen pulse (mL O
2
beat
− 1
).
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663 Training & Testing
Ruchat S-M et al. Walking Program of Low … Int J Sports Med 2012; 33: 661–666
Exercise program
Participants exercised at their calculated target HR zone of 30 %
HRR or 70 % HRR 3–4 times per week. At each exercise session,
participants wore a HR monitor (Polar Pacer
®
, USA) to ensure
they were exercising within the predetermined target HR zone.
The first week consisted of 25 min of walking per session (5 min
of warm-up, 15 min of specific exercise and 5 min of cool-down).
The warm-up started at 4.8 km/h with no incline and was
ramped up over the 5-min warm-up to the speed and incline
corresponding to 30 % HRR or 70 % HRR. The 5-min cool-down
was done at 4.8 km/h with no incline. Each subsequent week
thereafter, the time at the prescribed intensity increased by
2 min, until a maximum of 30 min was reached, plus 5 min
warm-up and 5 min cool-down. This duration was maintained
until the end of the intervention (34–36 weeks of gestation).
Participants were required to attend at least one exercise session
per week at the lab in order to monitor adherence to the exercise
program and to determine the weekly gestational weight gain.
All exercise sessions were recorded in exercise logs.
Nutrition program
During the intervention, each participant followed a modified
gestational diabetic dietary plan for pregnancy, as previously
described [ 20 ] . Briefly, the specific goals of the nutrition pro-
gram were as follows: 1) to individualize the total daily energy
intake recommendation to favor progressive weight gain
(approximately 8 360 kJ per day (2 000 kcal/day)); 2) to individu-
alize the daily carbohydrate intake to 40–55 % of total energy
intake while distributing carbohydrate intake throughout the
day with 3 balanced meals and 3–4 snacks per day, emphasizing
complex carbohydrates and low-glycemic index foods; 3) to
individualize the total daily fat intake to 30 % of total energy
intake (substituting monounsaturated and polyunsaturated
fatty acids for saturated and trans-fatty acids), with the remain-
ing 20–30 % of energy intake dedicated to protein; and 4) to
meet daily micronutrient and fluid recommendations during
pregnancy [ 11 ] . On a weekly basis, all women were required to
complete a one-day dietary intake record form [ 8 ] that was ana-
lyzed using the ESHA Food Processor SQL
®
software (ESHA
Research, USA). Data were used to examine dietary adherence
and to give individualized feedback to each woman as needed.
Measurements
Self reported weight and height were used to calculate pre-preg-
nancy body mass index (BMI, kg/m
2
). Women were weighed in
the laboratory on a weekly basis. Body weight was rounded to
the nearest 0.1 kg (Healthometer, USA). Infant birth length and
weight were taken from medical records at delivery.
Statistical analyses
Student’s unpaired t-tests were used to examine differences in
descriptive characteristics between the LI and VI groups, as well
as differences in pre-exercise cardiorespiratory variables meas-
ured at study entry. Changes (i. e., from pre- to post-interven-
tion) in cardiorespiratory variables measured pre-exercise and
during steady-state treadmill exercise tests were examined
using ANCOVA. Changes in cardiorespiratory variables measured
pre-exercise and during exercise were adjusted for respective
variables measured at study entry. Analyses were performed
with SAS (SAS Institute, Cary, NC, USA). Results are presented as
means ± SD. P-values of ≤ 0.05 identified statistical significance.
Results

Participants
Fourty-four of the 72 participants completed all testing time
points (LI group, n = 23 and VI group, n = 21). Prior to randomiza-
tion, 7 women decided not to continue participating after the
peak test, 7 women (LI group, n = 4, VI group, n = 3) dropped out
due to reasons unrelated to exercise, 9 women (LI group, n = 6, VI
group, n = 3) dropped out due to time commitment concerns and
5 women (VI group) had missing cardiorespiratory data from the
pre- or post-intervention steady-state test.
No differences in participant characteristics were observed
between the 2 intensity groups ( ●

Table 1 ). All women delivered
healthy babies without complications. No differences between
the groups were observed for mean birth weights (LI,
3 559 ± 391 g; VI, 3 448 ± 397 g, p = 0.36) or ponderal index (LI,
2.7 ± 0.3 kg/m
3
; VI, 2.6 ± 0.3 kg/m
3
, p = 0.36). One woman in the LI
group delivered at 36 weeks of gestation and the baby was
healthy, with a birth weight of 3 430 g and birth length of 53 cm.
Intervention program
Women participated in the intervention program for a mean
duration of 18 weeks. The participants in the LI group exercised
at a HR of 119 ± 8 bpm (~31 % HRR) compared to the mean HR of
139 ± 7 bpm (~66 % HRR) for the VI group (p < 0.0001) during
their exercise sessions. As expected, maternal body mass
increased significantly with advancing gestational age but body
mass did not differ between the groups at the end of the study
(LI, 76.3 ± 8.5 kg; VI, 76.0 ± 8.1 kg, p = 0.91). Weekly rates of weight
gain during the intervention were within the recommendation
guidelines of a mean weight gain of 0.5 kg/week for normal
weight women during the second and third trimesters (LI,
0.54 ± 0.12 kg/week and VI, 0.51 ± 0.17 kg/week) [ 12 ] , with no
differences in the frequency of women who did not gain exces-
sively (LI, 56 % and VI, 62 %). Dietary intake record analyses
showed that the nutrition goals were reached in both groups at
the end of the intervention program. No differences in average
total daily energy intake (LI, 8 557 ± 1 814 kJ; VI, 8 661 ± 1 417 kJ,
p = 0.85), carbohydrate intake (LI, 272.4 ± 66.9 g (53 % of energy
Table 1 Participant characteristics for low- and vigorous-intensity groups.
Variables Low-intensity
(n = 23)
Vigorous-intensity
(n = 21)
Age (years) 31.0 ± 3.8 30.5 ± 4.5
Parity (n) 0 = 15 0 = 9
1 = 6 1 = 9
2 = 2 2 = 3
Prepregnancy body mass (kg) 61.7 ± 7.1 62.2 ± 5.7
Height (cm) 167 ± 0.1 168 ± 0.1
Prepregnancy BMI (kg/m
2
) 22.1 ± 1.7 21.9 ± 1.8
At study entry
Gestational age (weeks) 17.4 ± 1.4 17.0 ± 1.3
Body mass (kg) 66.6 ± 8.0 66.9 ± 6.1
Physical fitness level (peak VO
2
,
mL kg
− 1
min
− 1
)
27.2 ± 4.1 30.0 ± 6.6
Peak HR (bpm) 171 ± 15 177 ± 10
Peak VCO
2
(mL kg
− 1
min
− 1
) 28.8 ± 4.7 32.6 ± 6.6
Peak V
E
(L min
− 1
) 62.3 ± 13.8 71.0 ± 14.6
Peak O
2
pulse (mL O
2
beat
− 1
) 10.7 ± 1.8 11.3 ± 2.5
Values are means ± SD
BMI, body mass index; HR, heart rate
VO
2
, oxygen uptake: VCO
2
, carbon dioxide output; V
E
, ventilation


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664 Training & Testing
Ruchat S-M et al. Walking Program of Low … Int J Sports Med 2012; 33: 661–666
intake); VI, 262.6 ± 58.1 g (51 % of energy intake), p = 0.63), pro-
tein intake (LI, 93.0 ± 18.7 g (18 % of energy intake); VI,
95.7 ± 31.8 g (19 % of energy intake), p = 0.75) and fat intake (LI,
70.4 ± 25.2 g (28 % of energy intake); VI, 75.6 ± 15.0 g (31 % of
energy intake), p = 0.43) were found between the groups.
Pre-exercise cardiorespiratory variables while standing
on the treadmill
At study entry, no differences in pre-exercise HR, VO
2
(L min
− 1
),
VCO
2
(L min
− 1
) and V
E
were observed between the groups. From
pre- to post-intervention, significant (p ≤ 0.05) increases in VO
2

(L min
− 1
), VCO
2
(L min
− 1
) and V
E
measured pre-exercise were
observed in both groups ( ●

Table 2 ). In addition, an increase in
pre-exercise HR was observed in the LI group (6 ± 14 bpm,
p = 0.001) but not in the VI group (3 ± 11, p = 0.79).
Cardiorespiratory responses at the end of 20 min of
steady-state treadmill exercise
From pre- to post-intervention, women in the LI group pre-
sented significant increases in HR (6 ± 12 bpm, p = 0.03), absolute
VO
2
(0.16 ± 0.12 L min
− 1
, p < 0.0001) and VCO
2
(0.12 ± 0.12 L
min
− 1
, p = 0.0009) during exercise, whereas women in the VI
group presented no changes in these variables ( ●

Table 3 ). When
body mass was taken into account, VO
2
and VCO
2
did not change
in the LI group but decreased in the VI group (VO
2
: − 1.25 ± 2.71 mL
kg
− 1
min
− 1
, p = 0.02; VCO
2
: − 1.50 ± 2.64 mL kg
− 1
min
− 1
, p = 0.005).
Both groups presented a significant increase in oxygen pulse
(LI, 1.02 ± 1.04 mL O
2
beat
− 1
, p < 0.0001; VI, 0.77 ± 0.96 mL O
2

beat
− 1
, p = 0.002) and in V
E
(LI, 3.56 ± 3.91 L min
− 1
, p = 0.002; VI,
3.03 ± 6.10 L min
− 1
, p = 0.01) post-intervention compared to pre-
intervention.
Discussion

In the present study, we investigated the effect of a walking pro-
gram of low or vigorous intensity during the second and third
trimesters of pregnancy, combined with nutritional control, on
maternal cardiorespiratory responses to a standardized sub-
maximal treadmill exercise test. When examining cardiorespi-
ratory variables measured pre-exercise, we found that although
both groups presented increases in absolute VO
2
and VCO
2
, and
in V
E
with advancing gestational age, which agrees with previ-
ous observational studies [ 14 , 23 , 24 ] and exercise intervention
studies [ 16 , 36 ] , HR did not change in the VI group but increased
in the LI group in late pregnancy. This increase in pre-exercise
HR in late gestation in the LI group was intriguing because previ-
ous exercise intervention studies reported no changes in resting
HR between the second and third trimester in both the exercis-
ing and control groups [ 16 , 22 , 27 ] .
With advancing gestation and the associated increase in mater-
nal body mass, weight-bearing exercise has been found to be
Table 3 Cardiorespiratory responses at the end of 20 min of steady-state treadmill exercise for low- and vigorous-intensity groups.
Variables Group Pre-intervention
(16–20 weeks)
Post-intervention
(34–36 weeks)
Change
1

HR (bpm) Low intensity 117 ± 10 123 ± 12 6 ± 12*
Vigorous intensity 143 ± 11 140 ± 14 − 3 ± 13
VO
2
(L min
− 1
) Low intensity 0.84 ± 0.17 1.00 ± 0.17 0.16 ± 0.12*
Vigorous intensity 1.45 ± 0.37 1.52 ± 0.32 0.07 ± 0.20
VO
2
(mL kg
− 1
min
− 1
) Low intensity 12.57 ± 2.21 13.34 ± 2.25 0.77 ± 1.89
Vigorous intensity 21.46 ± 4.47 20.21 ± 3.81 − 1.25 ± 2.71*
Oxygen pulse (mL O
2
beat
− 1
) Low intensity 7.24 ± 1.51 8.26 ± 1.52 1.02 ± 1.04*
Vigorous intensity 10.05 ± 2.27 10.82 ± 2.03 0.77 ± 0.96*
VCO
2
(L min
− 1
) Low intensity 0.82 ± 0.16 0.94 ± 0.16 0.12 ± 0.12*
Vigorous intensity 1.43 ± 0.36 1.48 ± 0.28 0.05 ± 0.19
VCO
2
(mL kg
− 1
min
− 1
) Low intensity 12.17 ± 1.86 12.41 ± 2.04 0.23 ± 1.69
Vigorous intensity 21.23 ± 4.21 19.73 ± 3.17 − 1.50 ± 2.64*
V
E
(L min
− 1
) Low intensity 28.66 ± 4.63 32.22 ± 5.83 3.56 ± 3.91*
Vigorous intensity 47.26 ± 10.99 50.29 ± 9.95 3.03 ± 6.10 *
Values are means ± SD. HR, heart rate; VO
2
, oxygen uptake; VCO
2
, carbon dioxide output; V
E
, ventilation

1
post- minus pre-intervention
*significant change (from pre- to post-intervention) within a group

Variables Group Pre-intervention
(16–20 weeks)
Post-intervention
(34–36 weeks)
Change
1

HR (bpm) Low intensity 95 ± 12 101 ± 14 6 ± 14*
Vigorous intensity 88 ± 12 91 ± 8 3 ± 11
VO
2
(L min
− 1
) Low intensity 0.26 ± 0.05 0.33 ± 0.05 0.07 ± 0.04*
Vigorous intensity 0.29 ± 0.04 0.32 ± 0.06 0.03 ± 0.04*
VCO
2
(L min
− 1
) Low intensity 0.25 ± 0.04 0.31 ± 0.07 0.07 ± 0.07*
Vigorous intensity 0.27 ± 0.04 0.29 ± 0.05 0.03 ± 0.03*
V
E
(L min
− 1
) Low intensity 11.01 ± 1.45 12.60 ± 1.92 1.59 ± 1.89*
Vigorous intensity 11.65 ± 1.36 12.26 ± 1.35 0.61 ± 1.32*
Values are means ± SD. HR, heart rate; VO
2
, oxygen uptake; VCO
2
, carbon dioxide output; V
E
, ventilation

1
post- minus pre-intervention
*significant change (from pre- to post-intervention) within a group
Table 2 Pre-exercise cardiores-
piratory variables while standing
on the treadmill for low- and
vigorous-intensity groups.
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Ruchat S-M et al. Walking Program of Low … Int J Sports Med 2012; 33: 661–666
less effi cient and cost more energy, as reflected by increases in
HR, absolute VO
2
, VCO
2
and V
E
during walking [ 4 , 25 ] . Althought
we observed increases in HR, absolute VO
2
and VCO
2
during
treadmill exercise in the LI group but not in the VI group from
pre- to post-intervention, we found an increase in V
E
in both
groups. Because V
E
has been reported to increase throughout
pregnancy during weight-supported exercise as well [ 22 , 23 ,
25 , 36 ] , it is likely that the increase in V
E
during weight-bearing
exercise is mainly due to pregnancy-induced increases in pro-
gesterone levels, known to be a strong respiratory stimulant
[ 13 ] . As shown by our results and those of previous intervention
studies [ 22 , 36 ] , pregnancy-induced increases in V
E
were not
modified by an exercise program, regardless of exercise intensity.
Given that the energy cost of walking is directly related to body
weight, it is more appropriate to consider cardiorespiratory
responses to walking in relative terms (mL kg
− 1
min
− 1
) during
pregnancy since maternal body mass increases. In the present
study, no changes in relative VO
2
and VCO
2
were found in the LI
group from pre- to post-intervention but decreases in these var-
iables were observed in the VI group. The consistency of relative
VO
2
and VCO
2
in the LI group indicates that the energy cost of
walking was not affected by a significant increase in maternal
body weight, whereas the decrease in these variables in the VI
group reflects a decrease in the energy cost of walking. Our find-
ings therefore suggest that both groups experienced an improve-
ment in submaximal aerobic capacity, with the improvement
being greater in the VI group. This agrees with the ACSM sugges-
tion that an intensity equivalent to approximately 30 % HRR does
achieve an aerobic benefit in pregnant women. These findings
are also in accordance with those based on non pregnant popu-
lations showing that aerobic exercise training of higher intensity
is more effi cient in improving aerobic fitness and that 30 % VO
2

reserve is the minimal effective training intensity for lower fit
subjects [ 9 , 28 ] .
Previous studies investigated relative VO
2
throughout pregnancy
in sedentary or active women. In accordance with what we
found, Clapp [ 4 ] reported that the increase in walking effi ciency
seen from preconception to early pregnancy was maintained
throughout the remainder of pregnancy in both recreational
athletes exercising at 50 % of their preconceptional exercise regi-
men (i. e., at least 3 exercise sessions per week at 50–85 % of
VO
2max
for ≥ 30 min) and those who stopped training. The
women who stopped training were considered “non-exercisers”,
defined as less than 3 exercise sessions per week at 50–85 % of
VO
2max
for ≤ 30 min during pregnancy. This suggests that they
may still have been physically active (daily physical activities
were not recorded) and may explain why they maintained walk-
ing effi ciency. Pivarnik et al. [ 25 ] examined relative VO
2
through-
out pregnancy in sedentary women who did not participate in a
regular prenatal exercise program. However, the women per-
formed exercise tests at 4 week intervals, from 13 to 36 weeks of
gestation. The exercise tests consisted of four 5-min bouts, with
a 10-min rest between each bout; 2 tests were performed on a
cycle (50 Watt and 75 Watt) and 2 tests on a treadmill (4.0 km/h,
2.5 % grade; 4.0 km/h, 12 % grade). No changes in relative VO
2

were found during walking as pregnancy progressed, regardless
of exercise intensity. In addition, Blackburn and Calloway [ 3 ]
reported no change in caloric cost (kcal kg
− 1
min
− 1
) of walking
from the end of the second trimester throughout the remainder
of pregnancy. No information was given about prepregnancy
physical fitness levels. Although women included in the study of
Pivarnik et al. [ 25 ] and Blackburn and Calloway [ 3 ] did not par-
ticipate in a regular exercise program, they may have walked on
a regular basis throughout pregnancy. All categories of physical
activities were shown to decrease during pregnancy, except
walking, which increased in the 3
rd
trimester [ 18 ] . These obser-
vations suggest that walking is an important aerobic activity for
pregnant women and should not be ignored as walking is a form
of weight-bearing activity that may help to maintain aerobic fit-
ness.
Another indicator of an improvement in aerobic capacity is an
increase in oxygen pulse. From pre- to post-intervention, both
groups presented an increase in oxygen pulse. Oxygen pulse
reflects the amount of oxygen taken up by the pulmonary circu-
lation in a heart beat. It can also be calculated as the product of
stroke volume and arterio-venous oxygen difference [ 2 ] . Thus,
an increase in oxygen pulse may be attributable to an increase in
stroke volume and/or in arterio-venous oxygen difference, the
latter reflecting increased oxgen uptake by the tissues. More
research is needed to evaluate the underlying mechanisms
responsible for an increase in oxygen pulse in response to a pre-
natal low and vigorous intensity walking program.
To the best of our knowledge, this is the first study to investigate
the effect of a walking program of 2 different intensities, com-
bined with nutritional control, on maternal cardiorespiratory
responses to a standardized submaximal treadmill exercise test.
Strengths of the present study include the randomization into 2
exercise program intensities, the use of personalized target HR
based on data from the peak test performed at study entry to
prescribe and monitor exercise intensity, and the use of breath-
by-breath technology during steady-state exercise tests to meas-
ure cardiorespiratory responses. By using a modified GDM
dietary program, we ensured that the dietary intake of fluid,
macronutrient and micronutrient recommendations of preg-
nancy were met (IOM, 2006). There are no studies that we are
aware of that have a nutritional control factor included as regi-
mented as ours. Thus, the combination of an exercise program
with nutrition control is a potential strength of our study.
Despite these strengths, one limitation of our study was the lack
of a non-exercise control group.
In summary, the present study showed that the energy cost of
walking was not affected by the increase in maternal body
weight in the LI group and was decreased in the VI group. Our
findings therefore suggest that both groups experienced an
improvement in submaximal aerobic capacity, with the
improvement being greater in the VI group. Women in the LI and
VI groups presented similar body mass throughout the interven-
tion and all delivered healthy babies, demonstrating that par-
ticipating in a prenatal walking program of low or vigorous
intensity, combined with healthy eating habits, is an important
component of a healthy pregnancy and is beneficial to the
mother and fetus.
Acknowledgements

The study was supported by a Canadian Institues of Health
Research (CIHR) – Institute of Aboriginal Peoples' Health (IAPH)
grant. SM Ruchat was supported by a postdoctoral fellowship
from the Canadian Diabetes Association. MH Davenport was
supported by a doctoral research award from the CIHR.
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