Guidelines - Physical Activity Throughout Pregnancy
This tool provides information to facilitate physical activity recommendations for pregnant women without contraindications.
Focused examination
1. Patient History
-
Identify absolute and relative contraindications to exercise.
Absolute contraindications:
-
Ruptured membranes, premature labor, unexplained persistent vaginal bleeding, placenta praevia after 28 weeks gestation, pre-eclampsia, incompetent cervix, intrauterine growth restriction, high-order multiple pregnancy (e.g. triplets), uncontrolled type I diabetes, uncontrolled hypertension, uncontrolled thyroid disease, and other serious cardiovascular, respiratory or systemic disorders
Relative contraindications:
-
Recurrent pregnancy loss, gestational hypertension, a history of spontaneous preterm birth, mild/moderate cardiovascular or respiratory disease, symptomatic anaemia, malnutrition, eating disorder, twin pregnancy after the 28th week, and other significant medical conditions
2. Physical Examination
-
Determine the existence of diastasis recti.
-
Women who develop diastasis recti should avoid abdominal strengthening exercises as this may worsen the condition, increasing the likelihood of requiring postnatal repair.
-
Continuing aerobic exercise, such as walking, is associated with decreased odds of developing diastasis recti.
-
-
Women considering athletic competition or exercising significantly above the recommended guidelines should speak to their obstetric care provider prior to doing so.
-
Elite athletes who continue to train during pregnancy are advised to seek supervision from an obstetric care provider with knowledge of the impact of vigorous-intensity physical activity on maternal, fetal, and neonatal outcomes.
Diastasis Recti:
-
Defined as the separation of the rectus abdominis muscles by an abnormal distance. Diastasis recti might cause a bulge in the middle of the abdomen where the two muscles separate
3. Management
-
The Physical Activity Readiness Medical Examination for Pregnancy (PARmed-X for Pregnancy) is recommended for use as a health screening prior to participation in physical activity.
-
Discuss the range of physical activity recommendations with the patient and, together, select the option this is right for them.
Recommendations:
-
All women without contraindication should be physically active throughout pregnancy including women who were previously inactive, women diagnosed with gestational diabetes mellitus, women categorized as overweight or obese (pre-pregnancy body mass index ≥25 kg/m²)
-
Complete at least 150 min of moderate-intensity physical activity each week
-
Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged
-
Incorporate a variety of aerobic and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial
-
Pelvic floor muscle training (PFMT) (e.g., 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: instructions / video
-
Modify exercise position to avoid the supine position light-headedness, nausea or unwell feeling is experienced while lying flat on back
4. Reevaluation and Discharge
-
Reassess the patient at every visit.
-
Monitor for any emerging contraindications to exercise.
5. Referrals and Collaboration
-
Refer the patient to a physician for further evaluation at any time during their care if they develop new or worsening contraindications or psychological symptoms.