Exercise in Pregnancy for Reduction of Blood Pressure in Obese Patients
Condition: Hypertension; Pregnancy; Preeclampsia; Exercise
MeSH terms: Pre-Eclampsia; Hypertension
Study type: Interventional

Summary: 
      Preeclampsia and other high blood pressure disorders of pregnancy are a significant cause of
      both maternal and fetal complications of pregnancy. To date, there is no known "cure" for
      preeclampsia, but studies have shown that exercise may lower the risk of preeclampsia and
      high blood pressure disorders in pregnancy. Resistance training also lowers blood pressure,
      and may be easier to perform in a pregnant population, leading to higher compliance. The
      investigators propose to perform a novel prospective study of a resistance training regimen
      on blood pressure in pregnant patients at high risk for developing preeclampsia or high blood
      pressure.
    

Detailed description: 
      Hypertension affects 5-10 percent of pregnancies, and complications from hypertensive
      disorders of pregnancy are the third leading cause of maternal death in the United States.
      Hypertensive disorders of pregnancy, including preeclampsia, lead to preterm delivery,
      morbidity and mortality of mother, fetus, and neonate, and are a predictor of development of
      chronic maternal hypertension, cardiovascular disease, and renal disease. Maternal obesity is
      increasing dramatically in the patient population, and is an independent risk factor for
      hypertension and preeclampsia, increasing the risk by two- to four-fold. To date, no
      effective preventative measure has been found to reduce the risk of preeclampsia or
      hypertension in high risk pregnant patients. However, observational studies have shown that
      patients who exercise or who have increased physical activity before and during pregnancy
      have lower rates of preeclampsia, hypertension, and gestational diabetes. Exercise has been
      shown in numerous studies to be safe in pregnancy, and is recommended by the American College
      of Obstetrics and Gynecology as part of routine prenatal care. However, aerobic exercise can
      be viewed by patients to be difficult to perform during pregnancy, particularly when the
      patient is obese and at later gestations. Adherence to exercise regimens is therefore low in
      this patient group. Dynamic resistance training has been shown to lower mean blood pressure
      both acutely and long term in non-pregnant hypertensive patients, and can be performed more
      easily by patients with mobility issues. This intervention has not been studied in an obese
      pregnant population for its effects on blood pressure throughout pregnancy.

      The long term goal is to develop an intervention that will reduce the barriers to exercise of
      obese pregnant women that will, in turn, reduce their risk of developing preeclampsia and
      other hypertensive disorders of pregnancy. The specific objective of this proposal is to
      study the effect of a structured resistance training exercise intervention on blood pressure
      in obese pregnant woman, who would be considered high risk for development of hypertensive
      disorders based on pre-pregnancy BMI. The central hypothesis is that obese pregnant patients
      who participate in a regular, structured resistance training exercise regimen will have a
      decrease in mean arterial blood pressure compared to obese pregnant patients who are strongly
      encouraged to do aerobic exercise (lifestyle intervention) or who participate in routine
      prenatal care. The investigators formulated this hypothesis, in part, based upon previous
      studies found in the literature performed in non-pregnant hypertensive patients. The
      investigators will extrapolate from the experience and methods of the collaborators, who have
      studied the effects of exercise on gestational diabetes.
    

Intervention name(s): Exercise support; Exercise intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Group B (exercise support) will be given the ACOG pamphlet on exercise in pregnancy, a daily activity log, and a pedometer. This group will be asked to wear the pedometer for 7 consecutive days between Visits 1 and 2, and record daily activities.; Group C (exercise intervention) will be given the ACOG pamphlet on exercise in pregnancy, a daily activity log, a pedometer, a resistance band, and a handout on specific exercises (type and frequency) to be performed. The study coordinator will demonstrate each exercise and then observe the participant perform each exercise to assure full understanding. In addition to wearing the pedometer for 7 days and completing the activity log, this group will also record compliance with the exercise regimen.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Pregnancy; Exercise; Hypertension; Preeclampsia; Resistance exercise