Most guidelines recommended activities to engage in during pregnancy. All but the French and Spanish guidelines indicated duration or total time and all but the Australian and French guidelines indicated frequency of physical activity. For most guidelines, intensity was indicated as moderate or vigorous, or in absolute (e.g., heart rate) or relative (e.g., rating of perceived exertion) indicators.
| Guidelines | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Australia | Canada | Denmark | France | Japan | Norway | Spain | United Kingdom | United States (ACOG) | United States (USDHHS) | |
| General Exercise Recommendations: | ||||||||||
| Cool down | X | X | X | |||||||
| Duration or total time, specified | X | X | X | X | X | X | X | X | ||
| Drink water or stay hydrated | X | X | X | X | ||||||
| Flat place | X | |||||||||
| Frequency, specified | X | X | X | X | X | X | X | X | ||
| Intensity: | ||||||||||
| Moderate | X | X | X | X | X | X | ||||
| Vigorous | X | X | X | |||||||
| Absolute (heart rate) | X | X | X | X | ||||||
| Relative (RPE) | X | X | X | X | ||||||
| Start new exercise program | X | X | X | X | X | X | X | X | X | |
| Time (10am–2pm) | X | |||||||||
| Warm-up | X | X | X | |||||||
| Wear light clothes | X | |||||||||
| Examples of Specific Activites To Do: | ||||||||||
| Aerobic activities | X | low impact | implied by duration and intensity | X | X | X | X | implied by duration and intensity | X | |
| Cross country skiing | X | |||||||||
| Nordic walking | X | |||||||||
| Pelvic floor exercise | X | X | X | |||||||
| Stationary cycling | X | X | ||||||||
| Strengthening | X | X | X | X | X | |||||
| Stretching | X | X | X | X | ||||||
| Walking | X | X | X | X | ||||||
| Water exercise, swimming | X | X | X | X | X | X | ||||
| Yoga | X | |||||||||
| Examples of Activites To Do With Caution: | ||||||||||
| Bowling | X | |||||||||
| Cross country skiing | X | |||||||||
| Horseback riding | X | |||||||||
| Golf | X | |||||||||
| Gymnastics | X | |||||||||
| Jogging, mild | X | |||||||||
| Racquet sports | X | |||||||||
RPE = rating of perceived exertion
Type
All
but the French guidelines specified aerobic activities as an acceptable
modality. Guidelines from Australia, Canada, Denmark, Norway, and the
United Kingdom also recommended strengthening exercises. Only Spain provided a list of activities to perform with caution.
Frequency and Duration
Most
guidelines (with the exception of those from France) included
information on frequency and/or duration of exercise. Specifically,
Canada and the United Kingdom indicated a minimum of 15 minute sessions
for 3 times per week, progressing to 30 minutes, 4 times per week even
if intensity was reduced. Denmark recommended at least 30 minutes of
moderate intensity activity daily. Japan recommended aerobic exercise
for up to 60 minutes, 2 to 3 times per week. Norway recommended 30
minutes per day of aerobic activity. Spain recommended a frequency of 3
times per week with no duration specified. The US ACOG recommended
accumulating 30 minutes or more of moderate exercise on most if not all
days of the week. The USDHHS indicated that “healthy women who are not
already highly active or doing vigorous-intensity activity should get at
least 150 minutes (2 hours and 30 minutes) of moderate-intensity
aerobic activity per week during pregnancy and the postpartum period.
Preferably this activity should be spread throughout the week”.
Intensity
For
absolute intensity, heart rate guidance was provided by Canada, Japan,
Spain, and the United Kingdom. Guidelines from Canada and the United
Kingdom specified heart rates accounting for age; however, Japan and
Spain recommended heart rates less than 150 and 140 beats per minute,
respectively. The Canadian guideline advised working in the lower ends
of the heart rate zone if starting a new exercise program or in late
pregnancy. The target heart rate zones provided by Canada represented
60% to 80% of maximal aerobic capacity. The United Kingdom guideline
advocated for an “upper range of 60% to 90% maximal heart rate for women
wishing to maintain fitness during pregnancy” (page 4), and 60% to 70%
of maximal heart rate for women who were sedentary prior to pregnancy.
The Norwegian guideline recommended that aerobic exercise intensity
should not exceed 70% to 75% of maximal oxygen uptake, instead advising
use of a talk test (being able to talk while exercising) or the Borg’s
rating of perceived exertion scale.
Canada and the United Kingdom also mentioned the usefulness of the
“talk test”. The lowest guidance on intensity was from Spain, which
recommended not exceeding 50% of maximal oxygen consumption.
For
relative intensity, Canada, Norway, and the United Kingdom recommended
perceived exertion of 12 to 14, just above or below “somewhat hard”,
which generally coincided with moderate intensity. Japan recommended a
perceived exertion less than 13 (somewhat hard) or 14, and for
continuous exercise to be less than 11 (fairly light) or 12.
The
French guideline recommended that beginning or continuing moderately
intense sport physical activity during pregnancy was possible. The
USDHHS guideline indicated that “pregnant women who habitually engage in
vigorous-intensity aerobic activity or are highly active can continue
physical activity during pregnancy and the postpartum period, provided
that they remain healthy and discuss with their health-care provider how
and when activity should be adjusted over time”. The
Australian guideline condoned this: for healthy women not highly active
or engaging in vigorous activity, then moderate intensity was
recommended. The US ACOG stated that pregnant women should engage in
regular, moderate intensity physical activity in the absence of
contraindications.
Starting a New Exercise Program
All
but the US ACOG guidelines included guidance for women starting a new
exercise program during pregnancy. The Australian guideline suggested
that women could begin a light to moderate exercise program in
consultation with their doctor, and the Canadian guideline stated that
for uncomplicated pregnancies “women with or without a previously
sedentary lifestyle should be encouraged to participate in aerobic and
strength-conditioning exercises as part of a healthy lifestyle”. It indicated this generally was “in the second trimester, when the
nausea, vomiting, and profound fatigue of the first trimester have
passed and before the physical limitations of the third trimester begin”. In Japan, the guideline indicated that if a pregnant woman
started a sport during pregnancy, she should initiate it after 12 weeks’
gestation and confirm a normal pregnancy.
In
Norway and the United Kingdom, women engaging in new exercise programs
during pregnancy were encouraged to begin gradually with shorter
sessions of 15 minutes for 3 times per week, then increase gradually to
30 minute sessions 4 times a week, and eventually to daily sessions.
Spain recommended only initiating exercise slowly for previously
sedentary women, but did not provide specifics. The US ACOG guideline
indicated that previously inactive women should be evaluated before
physical activity recommendations are made and to increase the amount of
physical activity gradually over time. The USDHHS guideline also
indicated that “when beginning physical activity during pregnancy, women
should increase the amount gradually over time. The effects of
vigorous-intensity aerobic activity during pregnancy have not been
studied carefully, so there is no basis for recommending that women
should begin vigorous-intensity activity during pregnancy”.
Other Exercise Guidance
The
guidelines from Canada, Norway, and Spain suggested warming up and
cooling down before and after exercise, respectively. Australia, Canada,
Norway, and Spain also mentioned hydration during exercise. Norway’s
guideline also suggested wearing light clothes during exercise. Japan’s
guideline described environmental characteristics of the exercise, such
as choosing a flat place and exercising between 10am and 2pm, supported
by studies finding natural uterine contractions to be lower during that
time period.
References:
Borg G, Linderholm H. Perceived exertion and pulse rate during graded exercise in various age groups. Acta Med Scand. 1974;472:194–206.
Murooka H. Sports Medicine for Pregnant Women. Tokyo, Japan: Asakura Publisher; 1982. Required conditions and contraindications; pp. 57–70.
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