Client Consultation Report

Bri Rehborg

College of Science, Engineering, and Technology, Grand Canyon University

EXS-344: Exercise Science: Special Populations

Dr. Havenar

1/1/2023
 Introduction and Background

Definition

Patty is a 28-year-old female, who is two months pregnant with her first child. I am going

to help her by creating an exercise testing protocol, Nutritional and exercise recommendations,

and prescription. Patty found out she was pregnant from a pregnancy test a couple of weeks after

she and her husband were sexually active. Pregnancy is defined as “increasing weight gain over

an approximate 40-week period commensurate with the development of the baby and supportive

structures and is divided into trimesters each lasting approximately 12 to 13 weeks” (Jacobs,

2017). Throughout pregnancy, the hormones including estrogen, progesterone, human chorionic

gonadotropin, human placental lactogen, relaxin, and prolactin become increasingly more

prevalent (Jacobs, 2017). Estrogen has an anabolic effect on the body which allows for blood

vessel enlargement because the blood vessels need to be big enough to circulate for 2 humans

(Havenar, 2021). When a woman becomes pregnant the menstrual cycles stop, the uterine lining

thickens, and blood vessels and volume expand to accommodate and nourish the baby (Jacobs,

2017). This is the creation of a new life, and we are going to monitor and be preventative to have

a safe and healthy pregnancy to lead to a healthy baby.

Epidemiology

During pregnancy fetal growth and maternal health are dependent on sufficient maternal

weight gain and recommended weight maternal weight gain is dependent on the number of

fetuses and the beginning weight of the mother. Weight gain is crucial during pregnancy but if

the mother is underweight prior to conception that will increase the risk of preterm babies and

Infant death. If the mother is overweight prior to conception, this will: increase the rate of Birth

defects, large babies, preterm labor/ delivery, and increased risk of the child being obese.
Another factor to be aware of is that “hypertensive disorders affect 10 percent of all pregnant

women in the United States and were the cause of 6.8 percent of maternal deaths between 2011

and 2015” (Leeman et al., 2016). These parts of being pregnant are prevalent at the time of

pregnancy and society should be aware of the risks and how to prevent them.

Symptoms

There are many physical symptoms and physiological changes that are commonly

associated with pregnancy. Low back pain is common due to abdominal weight gain and changes

in hormones (Jacobs, 2017). Other common pregnancy symptoms include “frequency of

micturition (passing urine), fatigue, pelvic pressure [and pain], and insomnia”. One of the most

common ways to know if someone is pregnant is a missed menstrual cycle (period) and/ or

“morning sickness”, fatigue and nausea. If someone thinks they are pregnant they should take a

test right away and if that comes back positive, they should schedule an appointment with an

OBGYN.

Complications

Excessive weight gain in mothers can result in an increased risk of needing a c-section,

Increased weight retention, more difficulty losing excess weight after pregnancy, and postpartum

depression. This affects the child as well and it can increase the baby's risk for allergies, asthma,

and cancer (Havenar, 2021). The hormone relaxin softens ligaments of the pelvis but also

increases joint laxity and may affect other joints of the body and lead to inflammation and joint

pain. The hormone “progesterone can also cause hyperventilation episodes at rest due to

progesterone’s effect on the brain’s respiratory center” (Jacobs, 2017). Another major

complication of pregnancy is preeclampsia, which is pregnancy-induced high blood pressure.

Gestational diabetes is another risk during pregnancy, this happens when patients fail to maintain
glycemic goals through diet and exercise therapy (Mottola, 2008). preventative methods during

pregnancy are important to prevent complications during pregnancy because it not only affects

the mom but also the baby.

Behavior

During pregnancy many of the behavioral changes are due to symptoms or complications.

It is important to monitor someone throughout pregnancy and know what is normal and what is

not. During the first trimester weight gain of about 3.5 pounds is normal then after that patty

should gain about 1 pound per week leading up to birth. This weight gain is crucial to support

maternal health and baby growth. Another behavioral choice needs to be to meet caloric intake.

If this is not met it may result in hypoglycemia (e.g., low blood glucose levels) may occur,

resulting in nausea, fatigue, dizziness, and fatigue” (Jacobs, 2017). It is important for Patty to

monitor her behavioral changes and understand what is normal and what is not.

Exercise Impact

There are many benefits of exercise for pregnant women. Some of these healthy and

physiological benefits include muscle strength and endurance, increased energy, better posture,

sleep, mood, easier labor and delivery and to return to pre-pregnancy body shape. Exercise will

decrease the risk of preeclampsia which is pregnancy-induced high blood pressure/hypertension

and one of the main reasons to build bigger blood vessels (Havenar, 2021). Aerobic exercise

training can also reduce the incidence of gestational diabetes by 55% (Nasiri-Amiri et al., 2019).

Patty has done some physical activity in the past but nothing above moderate intensity. We will

focus on a light-to-moderate intensity program to meet her needs. It is important for Patty to

exercise in her lifestyle to support her and her baby.

 Exercise Testing

For pregnant individuals exercise testing is an important safety precaution for the mom

before exercise. We will begin prior to testing with an informed consent form and PAR- Q with

an outline of what will be done and what it will look like. We will begin with non-fatiguing tests

resting heart rate and blood pressure, height, and weight. For pregnant women the tests we will

be focusing on will be more biometrical, assessing weight gain, fetal heart rate, diet, uterine size,

and collecting subjective data. During exercise, it is important to measure intensity using the 6-

20 RPE scale and the goal is to be around 12-13. Being cautious is important and monitoring

what may harm the mom or baby is necessary.

Nutritional Recommendations and Prescription

Recommendations

For pregnant women, it is especially important that they tend to their nutritional needs.

This is the care of nourishing the mom's body and nourishing the baby's body to develop

healthily. It is recommended that preconception women consume 400 micrograms of folate per

day. Then that number should increase to 600 mg per day during pregnancy and is most crucial

during the first trimester because this helps with the baby's development and prevents birth

defects, such as Spina Bifida (Havenar, 2021). Other benefits of folic acid during pregnancy are

increased bone growth in the baby, prevention of excess bone loss in the mother, prevention of

brain defects, and oxygenating of blood to mother and baby. Sources of folate include dark green

leafy greens, nuts, beans, and citrus fruits (Havenar, 2021). Other recommendations for pregnant

women include 27 mg of iron, 1000 mg of calcium, and 600 IU per day. These vitamins and

minerals can be found in most prenatal vitamins to support baby growth and the mother's body.
 Prescription

Meals Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Breakfast -Smoothie -Orange -smoothie -oatmeal -Smoothie -Orange -oatmeal

with spinach juice with spinach with brown with spinach juice with brown
-eggs (2) -breakfast -toast with sugar peanut -eggs (2) -breakfast sugar,
-toast (1) sandwich peanut butter butter and -toast (1) sandwich peanut
-prenatal -prenatal (2) banana -prenatal -pineapple butter, and
vitamin vitamin -prenatal -green tea vitamin -prenatal banana
vitamin -prenatal vitamin -Orange
vitamin juice
-prenatal
vitamin

Morning Chia -smoothie -Yogurt with -smoothie Orange -smoothie -Orange

snack pudding with spinach granola and with spinach with spinach -chia
fruit pudding

Lunch -tuna salad -Lentil Mediterrane -3 pork tacos -tuna salad -Chicken -coconut
-celery vegetable an bean -chips and -celery caesar salad chickpea
-Potato chips soup salad salsa -Potato chips -whole grain vegetable
-Baby -crackers -Baby roll curry soup
cucumbers cucumbers -pita
(4) (4) -hummus

Afternoon Cashews Trail mix -Celery Trail mix -baby carrots Orange -baby carrots
snack -peanut -hummus Pineapple -raspberries
butter - Melon
raisins

Dinner Burrito bowl Chicken -Lasagna -Pulled pork -beef and -Spaghetti -chicken and
with teriyaki stir -brussels -corn break bean sloppy with spinach vegetable
chicken, fry sprouts -baked beans joe tomato sauce quesadilla
rice, beans, -potato -mashed -chicken -chips and
salsa, guac, wedges potatoes -asparagus salsa
lettuce, sour -collard -cooked - Corn
cream and greens carrots
cheese -brussels
sprouts

Evening Dark Ice cream Chocolate Dark Chocolate Dark Brownie

snack chocolate chia pudding chocolate chia pudding chocolate
coconut coconut coconut
 almonds almonds almonds
Exercise Recommendations and Prescription

Recommendations

My client has only done moderate intensity in the past so I will target this exercise

program regarding that. It is important not to incorporate vigorous activity since she has not done

it before so we will be doing light-moderate intensity exercise. The exercise recommendation is

at least 150 minutes of moderate intensity spread throughout the week (Havenar, 2021). It is

important to use the 6-20 RPE scale to assess intensity. An RPE scale is important because it is

subjective and allows me to gauge Patty’s perception of intensity. To assess heart rate, I will

multiply 10 by the given number. The target will be 13-14, which is moderate intensity/

somewhat hard. It is important to know this scale is subjective because women can have a

blunted heart rate response during pregnancy. The recommended frequency is 3-5 days a week

and do not exceed 5 days. Prescribing lower-skill-level activities that do not require a lot of

balance is important and good options include walking, stationary equipment, and swimming.

Prescription

Type Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Aerobic Water 45 min x 45 min x 45 min x 30 walk at

(4x/week) class aerobics steady state water moderate
(moderate aerobics intensity
intensity) class (brisk
stationary walk)
bike

Resistance x → Seated chest x x x → 3x x

Training press (superset)
(2x/ week) 3x15 15 Frontal
3 min rest dumbbell
→ Standing raises with 2
cable row minutes rest
 3x12 15 lateral
2 min rest dumbbell
→ RDLs raises with 3
2x15 minutes rest
3 min rest → 3x 10/10
→ Wide stance reverse
squats lunges with
3x12 light dB
2 min rest weight
holding
**(intensity hands at the
60% of a side
10RM) 3 minutes
rest
→ 2x 12
TRX rows
2 minutes
rest

Flexibility → 15 minutes → 15 minutes → 15 → 15 minutes → 15 → 15 → 15

(Daily) → Hold 10- → Hold 10-30 minutes → Hold 10-30 minutes minutes minutes
30 seconds seconds per → Hold 10- seconds per → Hold → Hold 10- → Hold 10-
per stretch to stretch to a 30 seconds stretch to a 10-30 30 seconds 30 seconds
a point below point below the per stretch to point below seconds per stretch to per stretch
the discomfort a point the discomfort per stretch a point below to a point
discomfort below the to a point the below the
discomfort below the discomfort discomfort
discomfort

Kegel/ 10 reps 10 reps 10 reps 10 reps 10 reps 10 reps 10 reps

pelvic 3 seconds/ 3 seconds/ 3 seconds/ 3 seconds/ 3 seconds/ 3 seconds/ 3 seconds/
floor actions actions actions actions actions actions actions
(isometric) (isometric) (isometric) (isometric) (isometric) (isometric) (isometric)
exercises
(daily)

Summary

● Use the 6-20 RPE scale to gauge intensity, the goal ist to stay between 12-13.

● Folate is crucial for the first trimester of pregnancy, this will help the baby's growth, the

mother's health and prevent birth defects such as spina bifida.

● Moderate-intensity exercise is the goal in our exercise program, this is equivalent to a

brisk walk. Stretching and Kegel exercises every day will help with pelvic flexibility and

strength.

● Weight gain is normal during pregnancy, it is recommended for normal weight, in which

you are to gain 3.5 lbs. in the first trimester and 1lb. each week after that.

● Common complications that occur during pregnancy are preeclampsia (pregnancy-

induced high blood pressure/ hypertension) and gestational diabetes, however doing

aerobic exercise will significantly decrease this risk.

Resources
Havenar, J. (2021). EXS 344 Female Specific Considerations [Slides 10-21]. Grand

Canyon University

Havenar, J. (2021).T7: Life Cycle Nutrition [Slides 1-10]. Grand Canyon University

Jacobs, P. L. (2017). NSCA's essentials of training special populations. Human Kinetics.

Leeman L, Dresang LT, Fontaine P. Hypertensive disorders of pregnancy. American

Family Physician. 2016;93(2)

Mottola M. F. (2008). The role of exercise in the prevention and treatment of gestational

diabetes mellitus. Current diabetes reports, 8(4), 299–304.

https://doi.org/10.1007/s11892-008-0053-7

Nasiri-Amiri, F., Sepidarkish, M., Shirvani, M. A., Habibipour, P., & Tabari, N. S. M.

(2019). The effect of exercise on the prevention of gestational diabetes in obese

and overweight pregnant women: a systematic review and meta-analysis.

Diabetology & metabolic syndrome, 11, 72. https://doi.org/10.1186/s13098-019-

0470-6

National Academies of Sciences, Engineering, and Medicine; Health and Medicine

Division; Division of Behavioral and Social Sciences and Education; Board on

Children, Youth, and Families; Committee on Assessing Health Outcomes by

Birth Settings; Backes EP, Scrimshaw SC, editors. Birth Settings in America:

Outcomes, Quality, Access, and Choice. Washington (DC): National Academies

Press (US); 2020 Feb 6. 3, Epidemiology of Clinical Risks in Pregnancy and

Childbirth. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555485/