Chapter 21
Exercise Guidelines and
Recommendations During
Pregnancy
Jacalyn J. Robert-McComb, PhD,
FACSM
Jessica Stovall, BS
Learning Objectives
Following this presentation, you should have an
understanding of:
 Physiological changes of pregnancy that may affect
exercise;
 Effects of exercise on the baby;
 Activities to encourage and discourage during
pregnancy;
 Guidelines for exercising while pregnant
 Postpartum exercise; and
 Contraindications to exercising while pregnant
Introduction

Mild and moderate exercise during pregnancy have
very positive effects on the mother and infant
Positive Effects of Exercise
Reduced typical pregnancy-related symptoms
 Reduced “active stage” of labor
 Increased sense of maternal well-being
 Decreased delivery complications
 Reduced risk developing pregnancy induced hypertension
 Reduced bone density loss during lactation
 Increased birth weight
 Reduced risk developing gestational diabetes

Gestational Diabetes Mellitus (GDM)

Researchers found a 76% decrease in GDM risk
in active women, or those who spent > 4.3 h .
wk –1 engaged in recreational physical activity,
compared with inactive women (Dempsey,
Sorensen, Williams, et al., 2004 ).

Perhaps one of the greatest incentives to
exercise moderately during pregnancy is that
children of GDM mothers are more likely to
have diabetes in adolescence or even become
obese (Dempsey, Butler, Williams, 2005 ).
Physiological Changes of Pregnancy

Musculoskeletal alterations


Change in center of gravity


joint laxity and hypermobility can cause injury during
exercise
Weight of growing breasts, uterus, and fetus
Temperature decreases slightly after exercise

Helps avoid overheating
Physiological Changes of Pregnancy Cont’

Cardiac output (CO)

Decreases 9% after 1st trimester when mother is in
supine position

Exercise should be avoided in supine position due to vena
cava compression
Motionless standing decrease CO 18%
 Lying on side best position for CO

Physiological Changes of Pregnancy Cont’

During exercise, blood diverted away from
abdominal viscera and uterus to exercising
muscles

This can be a concern when there is a decrease in
splanchnic blood flow by 50 percent (can cause fetal
hypoxemia)
Physiological Changes of Pregnancy Cont’

Increased oxygen demand


Inhibition of diaphragm because of enlarged uterus
Increase in energy demands
Pregnant women need to increase their caloric intake
by approximately 300 kcal per fetus.
 If the pregnant woman exercises, she needs to
increase her caloric intake to meet the energy cost of
the activity

Effects of Exercise on the Baby






Decrease risk of premature labor
Growth of placenta increased
Children scored higher on intelligence tests by
age 5
Children leaner
Babies seemed to handle stress of contractions
better
Babies had a decrease in likeliness of getting
tangled in umbilical cord
Activities to Encourage and
Discourage during Pregnancy

Activities Encouraged




Walking
Stationary cycling
low-impact aerobics
swimming

Activities Discouraged

Contact sports


hockey, wrestling, football, and
soccer
Sports with increase in falls

horseback riding, gymnastics,
skating, skiing, hang gliding,
vigorous racquet sports, weight
lifting, and scuba diving
Guidelines for Exercising while Pregnant

Clearance from physician prior to beginning
exercise program
PAREMED-X



Is one of the most often used screening tool
for pregnancy
This tool can be downloaded on the web at
http://uwfitness.uwaterloo.ca/PDF/parmedxpreg_000.pdf
Or you can use your search engine on the web
using the term PAREMED-X to find this form.
American College of Obstetricians and
Gynecologists Relative and Absolute Contradictions
to Aerobic Exercise During Pregnancy

Relative
Anemia
 Chronic bronchitis
 Extreme morbid obesity
 Extreme underweight
 Heavy smoker
 Orthopedic limitations
 Uncontrolled hypertension
(See Table 21.1 in the book for a
complete list)


Absolute
severe heart disease
 Restrictive lung disease
 Ruptured membranes
 Premature labor
 Continual 2nd or 3rd trimester
bleeding
 Incompetent cervix
(See Table 21.1 in the book for a
complete list)

Source: ACOG Committee. Opinion no. 267: exercise during pregnancy and the postpartum period. Obstet
Gynecol 2002;99:171-3 (with permission from American College of Obstetricians and Gynecologists
Summary of Recommendations for
Aerobic Exercise During Pregnancy

30 min or more of moderate exercise a day on
most days of the week, in absence of medical or
obstetric complications
3-5 METS; equivalent to brisk walking
 Ratings of perceived exertions useful (11-14) on the
6-20 Borg scale


Exercise sessions longer than 45 min not well
tolerated

Monitor hydration and body temperature
Indications to Stop Exercise During Pregnancy







Excessive shortness of breath
Chest pain
Extreme fatigue
Pelvic girdle pain
Vaginal bleeding
Muscle weakness
Headache
(Note: not limited to only these listed, see Table 21.3 in the book
for a complete list)
Strength Training during Pregnancy

Strength conditioning, weight training, and
stretching provides pregnant women with
improved level of muscular fitness

Help postural adjustments
Recommendations Regarding Resistance
Training during Pregnancy



Medical advice and physician recommendations should
be obtained prior to resistance training during
pregnancy.
Resistance training for all pregnant women may not be
appropriate. If women have any of the
contraindications to aerobic exercise as proposed by
American College of Obstetrics and Gynecology they
should not participate in resistance training.
Women who have never participated in resistance
training should not initiate one during pregnancy.
Recommendations Cont’d




Women should be encouraged to breathe normally during
resistance training, breath holding reduces oxygen delivery to the
placenta
Heavy resistance should be avoided since it may expose the
joints, connective tissue, and skeletal structures of an expectant
woman to excessive forces. An exercise set consisting of at least
12-15 repetitions without undue fatigue is recommended.
As training occurs, overload initially by increasing number of
repetitions and, subsequently, by increasing resistance.
Resistance training on machines if preferred to free-weights
because machines can be more easily controlled and require less
skill.
Source: Byrant C, Peterson J, Graves J. Muscular strength and endurance. In: Roitman J,
ed. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 3rd
ed. Philadelphia: Williams and Wilkins, 1998:448-455.
Royal college of Obstetricians and
Gynecologists Key Points for Exercise During
Pregnancy


Women should be encouraged to participate in
aerobic and strength-conditioning exercise as
part of a healthy lifestyle during pregnancy.
Reasonable goals of aerobic conditioning in
pregnancy should be to maintain a good fitness
level throughout pregnancy without trying to
reach peak fitness level or train for athletic
competition
Royal college of Obstetricians and Gynecologists
Key Points for Exercise During Pregnancy Cont’



Women should choose activities that will
minimize the risk of loss of balance and fetal
trauma
Women should be advised that adverse
pregnancy or neonatal outcomes are not
increased for exercising women
Initiation of pelvic floor exercises in the
immediate postpartum period may reduce the
risk of future urinary incontinence
Royal college of Obstetricians and Gynecologists
Key Points for Exercise During Pregnancy Cont’

Women should be advised that moderate
exercise during lactation does not affect the
quantity or composition of breast milk or
impact fetal growth
Source: Royal College of Obstetrics and Gynecologists. Exercise in pregnancy. RCOG Statement
No. 4 – January 2006; 1-6.
Postpartum Exercise

Benefits
Increased vitality
 Better overall mood and reduction in anxiety

Conclusion

Pregnant mothers:
Should obtain a clearance from their physician prior
to beginning exercise program.
 Must be aware of their imitations and exercise
within these limitations
 Educated appropriately for certain exercise


If exercise is performed properly, exercise is
very beneficial to both mother and baby during
pregnancy and the post partum period.