Evidence Based Physical Activity Guidelines Throughout Pregnancy
I wanted to highlight the 2019 Canadian Guidelines for physical activity throughout pregnancy because these guidelines have represented a meaningful shift in how pregnancy and exercise are approached clinically. Published in 2019 by Mottola, MF, Davenport, MH et al in the British Journal of Sports Medicine its goal was to provide guidance for pregnant women and obstetric care and exercise professionals on prenatal physical activity. These guidelines were informed by an extensive review of the literature and expert opinion. These guidelines have represented a meaningful shift in how pregnancy and exercise are approached clinically. Pelvic Floor/Health Physical Therapy is an important facet of care prenatally as well as postnatally. And as a Pelvic Floor Physical Therapist, I often am startled by how many myths take up space in social media, and as a result confuse and scare women. My hope is that by continuing to share consensus and researched information there can be more emphasis on helping women feel encouraged to continue or start exercising while pregnant for the physical and mental health, of both you and your baby.
Of significance is an explicit statement that prenatal physical activity should be considered front line therapy for reducing pregnancy complications and improving maternal physical and mental health. Previously the focus has more typically been on what women should avoid, limits around exertion, and how to prevent harm to the fetus. However, these guidelines state that prenatal physical activity should be front line therapy for reducing pregnancy complications and improving maternal physical and mental health.
Exceptions are recommended for women who have any of the following absolute or relative contraindications. Women with absolute contraindications during pregnancy can continue their activities of daily living but should not participate in more strenuous activities.
Absolute contraindications Include:
pre-eclempsia
intrauterine growth restriction
uncontrolled hypertension, type 1 Diabetes, or thyroid disease
ruptured membranes
premature labor
unexplained persistent vaginal bleeding
placenta previa after 28 weeks
incompetent cervix
high order multiple pregnancy eg, triplets
serious cardiovascular, respiratory or systemic disorder
Women with relative contraindications should discuss the advantages and disadvantages of moderate to vigorous intensity physical activity with their obstetric provider before they participate.
Relative Contraindications Include:
Recurrent pregnancy loss
gestational hypertension
history of spontaneous preterm birth
mild or moderate cardiovascular disease
symptomatic anaemia
malnutrition
eating disorder
twin pregnancy after 28th week
other significant medical conditions
Below are 6 key takeaways worth highlighting:
Women, with the exception of those with absolute contraindications, even if previously inactive, are encouraged to begin activity! Of course you are a beginner, scaling and beginning gradually would be recommended, and can also be done with an expert like Dr. Rachel, a Pelvic Floor Physical Therapist and Pelvic Health Specialist. But more importantly, pregnancy is not a reason to avoid starting an exercise regime if you were not already active.
The guidelines recommended moving beyond low intensity activity and specifically endorsed moderate - intensity aerobic exercise and resistance training. Ideally a combination of both aerobic and resistance activities is recommended with the goal of staying active throughout all 3 trimesters.
Pregnant women should aim to accumulate 150 minutes of moderate intensity activity per week.
(Moderate intensity activity is a heart rate range between 40-59% HRR).
It was also noted that more than the 150 minutes of exercise in frequency, duration, and volume were generally associated with greater health benefits, without a clear upper threshold being established.
Being active daily is encouraged but physical activity should ideally be accumulated over a minimum of 3 days per week
Pregnant women should aim to incorporate a variety of aerobic and resistance training for greater benefits. Adding yoga and stretching is also found to be helpful.
(This one I love) Pelvic Floor Muscle Training is recommended to help avoid urinary incontinence. Instruction on proper coordination is recommended for best outcomes and and optimizing benefits! I will also mention here that Pelvic Floor Physical Therapy that included pelvic floor muscle training is associated with a 50% reduction in prenatal and 35% reduction in postpartum urinary incontinence!!!
Women who experience light headedness, nausea, or feel unwell, when they exercise flat on their back should modify their exercise position and avoid being supine ( on their back).
It is really important to highlight that this consensus also notes after a systematic review of the literature that compared to no physical activity, accumulating at least 150 minutes of moderate intensity activity 3 or more days a week was associated with meaningful reductions in the odds of developing gestational diabetes, pre-eclempsia, and gestational hypertension. Perhaps the importance of exercise is underemphasized in terms of its value.
Overall, these guidelines summarize a representation in a shift from exercise being recommended to help improve quality of life, to a specific and clear prescription for reducing medical complications while pregnant and optimizing health for both the mother and the next generation.
Note: If you are curious about screening yourself to identify relative or absolute contraindications I am including a link to a recommended Screening Tool below -
The Physical Activity Readiness Medical Examination
Share this with your healthcare provider as a helpful tool to have a discussion specific to your pregnancy.
How to build a realistic weekly routine
A good pregnancy exercise plan should support health without becoming another source of stress. Start with what is repeatable.
Here is one simple weekly structure for someone cleared for activity and considers themselves more of a beginner:
Day | Activity |
Monday | 30-minute brisk walk |
Tuesday | 20 to 30 minutes of strength training |
Wednesday | 30-minute swim or low-impact cardio |
Thursday | Rest or gentle mobility |
Friday | 30-minute brisk walk |
Saturday | 20 minutes of strength training plus stretching |
Sunday | Easy walk or rest |
This is only an example. The same 150-minute goal can be reached in many ways.
A person with nausea may prefer 10-minute walks after meals. Someone with pelvic girdle pain may do better with swimming than long walks. Someone who already trained regularly may need a more specific program.
The best plan has these features:
It fits current symptoms
It includes rest days
It avoids high-risk activities
It can be adjusted week by week
It supports, rather than drains, daily life
Dr. Rachel values working with women prenatally and postpartum to address symptoms or be preventative.
Want to work together! Schedule a Virtual Discovery Call or an Evaluation through the link below
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