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Physical activity throughout pregnancy

Regular physical activity¬†is associated with health benefits, including improvements in physical and mental health, as well as decreased risk of chronic disease and mortality. Pregnancy is a unique period of a woman’s life, where lifestyle behaviours, including physical activity, can significantly affect her health, as well as that of her fetus. Although guidelines around the world recommend women without contraindication engage in prenatal physical activity, fewer than 15% of women will actually achieve the minimum recommendation of 150 min per week of moderate-intensity physical activity during their pregnancy.

Over the last three decades, the rates of pregnancy complications such as gestional diabetes mellitus, pre-eclampsia, gestational hypertension and newborn macrosomia have risen dramatically most likely as a consequence of rising rates of maternal obesity.

Who should be physically active during pregnancy?

All the women who do not have contraindications that would prevent them from engaging in physical activity. Women with absolute contraindications may continue the usual activities of daily living but should not participate in more strenuous exercise. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider.

Absolute contraindications Relative contraindications
Ruptured membranes, premature labour Recurrent pregnancy loss
Unexplained persistent vaginal bleeding History of spontaneous preterm birth
Placenta praevia after 28 weeks gestation Gestational hypertension
Pre-eclampsia Symptomatic anaemia
Incompetent cervix Malnutrition
Intrauterine growth restriction Eating disorder
High-order multiple pregnancy (eg, triplets) Twin pregnancy after the 28th week
Uncontrolled type I diabetes, uncontrolled hypertension or uncontrolled thyroid disease Mild/moderate cardiovascular or respiratory disease
Other serious cardiovascular, respiratory or systemic disorder Other significant medical conditions

Recommendations

  1. All women without contraindication should be physically active throughout pregnancy. Strong recommendation, moderate-quality evidence.
  2. Pregnant women should accumulate at least 150 min of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications. Strong recommendation, moderate-quality evidence.
  3. Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged. Strong recommendation, moderate-quality evidence.
  4. Pregnant women should incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial. Strong recommendation, moderate-quality evidence.
  5. Pelvic floor muscle training (PFMT) (eg, Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits. Weak recommendation, low-quality evidence.
  6. Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position. Weak recommendation, very-low quality evidence.

 

Safety precautions for prenatal physical activity

  • Avoid physical activity in excessive heat, especially with high humidity.
  • Avoid activities which involves physical contact or danger of falling.
  • Avoid scuba diving.
  • Avoid physical activity at high altitude (>2500 m).
  • Maintain adequate nutrition and hydration. Drink water before, during and after physical activity.

 

Reasons to stop physical activity and consult a healthcare provider

  • Persistent excessive shortness of breath that does not resolve on rest.
  • Severe chest pain.
  • Regular and painful uterine contractions.
  • Vaginal bleeding.
  • Persistent loos of fluid from the vagina indicating rupture of the membranes.
  • Persistent dizziness or faintness that does not resolve on rest.

Heart rate ranges for pregnant women

Maternal age Intensity Heart rate range (beats/min)
<29 Light 102-124
Moderate 125-146
Vigorous 147-169
30+ Light 101-120
Moderate 121-141
Vigorous 142-162

 

Conclusion

It is important that these Guidelines be implemented into clinical practice to achieve the significant and potentially lifelong health benefits for both the mother and the child.

 

References

Michelle F Mottola et al. 2019 Canadian guidelines for physical activity throughout pregnancy. Br J Sports Med 2018.

 

Author: admin2

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