What are the recommendations for

physical activity and exercise

during pregnancy?

Michael Zanovec
April 15, 2008

Artal & O’Toole. Br J Sports Med, 2003; 37:6-12.

Overview
• Key Points
• Physiological adaptive changes
• Maternal Benefits from Exercise
• Research
• Advising exercise in pregnancy
• Conditions requiring medical supervision
• Warning signs to terminate exercise
• General Guidelines
• Exercise Prescription
• Other considerations / activities to avoid
• Take Home Points
 Key Points
From the American College of Obstetricians and Gynecologists (ACOG)
Committee (2002).
• All women should be encouraged to participate in
aerobic and strength-conditioning exercise as part of a
healthy lifestyle during pregnancy

• Reasonable goals - maintain maternal fitness levels

• Choose activities to minimize risk to developing fetus

• Guidelines tailored to each individual woman

• As a woman’s pregnancy changes, so must her exercise

regimen

• Primary concern with exercise during pregnancy is safety

Artal & O’Toole. Br J Sports Med, 2003; 37:6-12.

Physiological adaptations
• Weight gain – effects
joints and balance
• Lumbar lordosis
• Increased ligamentous
laxity
• Increased uterine
activity?
• Increased risk of
preterm labor?
Physiological adaptations
• BMR and core temp. ↑ – ↑ risk of hyperthermia
• Increased maternal blood volume by 50%
• Cardiac output increases by 30-50%
• Decreased systemic vascular resistance
• Total lung capacity decreases by 5%
• 30-40% increase in tidal volume and minute
ventilation = chronic state of hyperventilation
Results in a circulatory reserve necessary to provide
nutrients and oxygen to mother and fetus at rest and
during moderate-intensity exercise
Benefits of Exercise during Pregnancy
• Reduces fatigue and helps manage stress
• Increases endurance and strengthening
muscles
• Help relieve back pressure
• Improve posture and balance
• Improve circulation & lowers
blood pressure
• Helps prepare for the strain of labor
• Improve self image
• Regain figure faster
Exercise Guidelines: Then & Now

ACOG 1985:
Old • Limit HR to 140
• No vigorous
activity > 15
min

vs.
New
Research – Exercise and Pregnancy
• Aerobic fitness can be maintained throughout
pregnancy
• Women wishing to resistance train need to avoid
supine exercises
• No relationship demonstrated between activity
levels and birth weight
• No human studies have shown that hyperthermia
associated with exercise is teratogenic
• Fetal heart rate may transiently increase or
decrease with maximal exercise but no adverse
birth outcomes
• Anatomic changes may predispose to
musculoskeletal injury
Advising exercise during pregnancy:
Steps to beginning an exercise program
• Clinical Evaluation
▫ Routine prenatal care is sufficient for monitoring exercise
program
• Medical Screening before exercise
▫ Overall health, obstetric, and medical risks reviewed
▫ Physical limitations / contraindications – evaluate throughout
pregnancy
• Exercise prescription - physical activity plan
▫ Consideration should be given to patient’s goals, initial fitness
level, and to balance frequency, intensity, duration, and
type of exercise so that the risks do not exceed the benefits
▫ Additional attention should be given to progression in
intensity over time
 Conditions requiring medical supervision
ABSOLUTE CONTRAINDICATIONS
• Cardiac disease
• Restrictive lung disease
• Persistent bleeding (2nd & 3rd trimester)
• Preeclampsia / PIH
• Preterm labor (previous/present)
• Cervical weakness
• Placenta previa after 26 wks
• Preterm pre-labor rupture of membranes
• Multiple gestation
 Conditions requiring medical supervision
RELATIVE CONTRAINDICATIONS
• Severe anemia (Hb < 100 g/L)
• Intrauterine growth restriction
• Poorly controlled hypertension, diabetes, thyroid
disease, or seizures
• Unevaluated maternal cardiac arrythmia
• Chronic bronchitis
• Extremely sedentary lifestyle
• Morbid obesity (BMI > 40)
• Malnutrition or eating disorder (BMI < 12)
• Orthopedic limitations
• Heavy smoker
General Guidelines – Where to start?
• In the absence of either medical or obstetric complications, follow
the current CDC-ACSM guidelines (Artal & O’Toole, 2003).
• For general health and well-being, accumulate at least 30 minutes of
moderate-intensity aerobic and/or muscle-strengthening exercise at
least 5 days/week (Haskell et al., 2007).
▫ Moderate intensity = 3-5 METs (equivalent to brisk walking)

• Stop if you feel pain.

• Finish eating at least 1 to 1 ½ hours before working out.
• Drink water before, during, and after your workout -- even if you
aren't thirsty.
• Don't go on a calorie-restriction diet during pregnancy. Eat a
nutritious, balanced diet.
• Basically, use common sense!
Warning signs to terminate exercise

• Excessive fatigue or shortness of breath

• Chest pain or palpitations
• Dizziness or fainting
• Abdominal pain
• Painful uterine contractions
• Leakage of amniotic fluid
• Vaginal bleeding
• Reduced fetal movement
• Muscle weakness
• Calf pain or swelling
 Exercise Prescription (FITT principle)
• For sedentary women
▫ Frequency = 3 x per week (minimum)
▫ Intensity = moderate RPE (12-14)
▫ Time = 30 minutes
▫ Type = low impact

• For regular exercisers

▫ Frequency = 3-5 x per week
▫ Intensity = moderate-to-hard RPE
▫ Time = 30-60 minutes
▫ Type = low impact and any prior safe activities

• For elite athletes

▫ Frequency = 4-6 x per week
▫ Intensity = 70-80% max HR or hard RPE
▫ Time = 60-90 minutes
▫ Type = competitive activities as tolerated during pregnancy
Adapted from Paisley et al. (2003)
 Energy expenditure and intensity of specific activities for a 140 lb.
female
700
Running, 10 min/mile, 6 mph
Energy Expenditure (kcal/h)

600

Running, 12 min/mile, 5 mph Vigorous intensity

500 (>6 METs)

400 Swimming – leisurely, general

300
Water aerobics
Moderate intensity
Vacuuming (3-6 METs)
200 Walking, 3 mph
Cleaning house
Yoga
100 Typing Light intensity
(<3 METs)
Sitting quietly
0
Recommended Exercises During Pregnancy

• Low impact aerobics

• Water aerobics
• Walking
• Kegels
• Pilates
• Yoga
• Cycling
• Swimming
Activities to avoid during pregnancy

• Avoid
▫ Scuba diving

▫ High altitude activities

▫ Activities with risk of fall

 Skiing, horseback riding,
skydiving

▫ Activities with risk of

abdominal trauma
 Hockey, basketball, soccer
Other Considerations
• Dehydration and hyperthermia:
▫ Avoid exercise in hot humid
environments
▫ Drink plenty of liquids – prior, during,
after
▫ Appropriate clothing may help dissipate
heat
▫ Hot tubs/saunas

• Poor Balance:
▫ Centre of gravity shifts as pregnancy
progresses
▫ Exercise cautiously
▫ Pay attention to changes to terrain

• Muscle cramps and soreness:

▫ Stretch muscles and warm-up before
exercising
▫ Wear supportive well cushioned shoes
Take Home Points
• Avoid exercise in the supine position after first
trimester
• Avoid prolonged periods of motionless standing
• Adequate nutrition
• Maintain hydration
• Avoid ballistic exercise
• Avoid exercise in hot humid environments
• Balance issues in third trimester
• Avoid contact sports/sports with risk blunt trauma
after first trimester/16-20 weeks
• Track fetal activity and uterine contractions
Take Home Points
• No standard heart rate maximum

• Exercise regimen based woman’s

symptoms

• Exercise recommendations vary with

each individual pregnant woman

• Discuss risks and benefits of exercise

• Use common sense

References
• Artal, R. & O’Toole, M. (2003). Guidelines of the
American College of Obstetricians and Gynecologists
for exercise during pregnancy and the postpartum
period. Br J Sports Med, 37, 6-12.
• Haskell, W. L., Lee, L. M., Pate, R. R.,Powell, K. E., Blair, S.
N., Franklin, B. A., et al. (2007). Physical activity and
public health: updated recommendation for adults from
the American College of Sports Medicine and the
American Heart Association. Med Sci Sports Exerc, 39(8),
1423-1434.
• Pivarnik, J. M., Chambliss, H. O., Clapp, J. F., Dugan, S.
A., Hatch, M. C., Lovelady, C. A., et al. (2006). Impact of
physical activity during pregnancy and postpartum on
chronic disease risk. Med Sci Sports Exerc, 38(5), 989-
1006.