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.

Patient Handouts

CCGI_Physical activity throughout pregna
CCGI_Physical activity throughout pregna

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​.

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CCGI is funded by provincial associations and regulatory boards, and national associations including the Canadian Chiropractic Association

and Canadian Chiropractic Protective Association. CCGI maintains editorial independence from funders.

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