Benefits, harms, and costs
- 1All women without contraindication should be physically active throughout pregnancy (strong recommendation, moderate quality evidence). Specific subgroups were examined:
- aWomen who were previously inactive (strong recommendation, moderate quality evidence).
- bWomen diagnosed with gestational diabetes mellitus (weak recommendation,a low quality evidence).
- cWomen categorized as overweight or obese (pre-pregnancy body mass index ≥25 kg/m2) (strong recommendation,b low quality evidence).
- 2Pregnant women should accumulate at least 150 minutes of moderate-intensityc physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications (strong recommendation, moderate quality evidence).
- 3Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged (strong recommendation, moderate quality evidence).
- 4Pregnant women should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial (strong recommendation, high quality evidence).
- 5Pelvic floor muscle training (e.g., Kegel exercises) may be performed on a daily basis to reduce the risk of urinary incontinence. Instruction in proper technique is recommended to obtain optimal benefits (weak recommendation,d low quality evidence).
- 6Pregnant women who experience light-headedness, experience nausea, or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position (weak recommendation,e very low quality evidence).
- •Ruptured membranes
- •Premature labour
- •Unexplained persistent vaginal bleeding
- •Placenta previa after 28 weeks’ gestation
- •Incompetent cervix
- •Intrauterine growth restriction
- •High-order multiple pregnancy (e.g., triplets)
- •Uncontrolled type 1 diabetes
- •Uncontrolled hypertension
- •Uncontrolled thyroid disease
- •Other serious cardiovascular, respiratory, or systemic disorder
- •Recurrent pregnancy loss
- •Gestational hypertension
- •A history of spontaneous preterm birth
- •Mild/moderate cardiovascular or respiratory disease
- •Symptomatic anemia
- •Eating disorder
- •Twin pregnancy after the 28th week
- •Other significant medical conditions
Strength of the Recommendations
Quality of the Evidence
Abbreviations:AGREE (Appraisal of Guidelines for Research and Evaluation (AGREE) II), CSEP (Canadian Society for Exercise Physiology), GDM (gestational diabetes mellitus), GRADE (Grading of Recommendations Assessment, Development and Evaluation), PFMT (pelvic floor muscle training), RCT (randomized controlled trial), SOGC (Society of Obstetricians and Gynaecologists of Canada)
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The following organizations have reviewed this document and endorse the Joint SOGC/CSEP Canadian Guidelines for Physical Activity throughout Pregnancy:• Alberta Health Services – Healthy Families and Children • Canadian Academy of Sports Medicine • Canadian Association of Midwives • College of Family Physicians of Canada • Directorate for Chief Medical Officer and Chief Scientist Office of Scotland • Exercise is Medicine Canada • Ontario Public Health Association • ParticipACTION • Perinatal Services BC • Sociedad Espanola de Ginecologia y Obstetricia (The Spanish Society of Gynecology and Obstetrics)
This article is being co-published in the British Journal of Sports Medicine (Mottola MF, Davenport MH, Ruchat S-M, et al. Br J Sports Med 2018;52:1339–1346. https://doi.org/10.1136/bjsports-2018-100056). This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Women have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice, women should be provided with information and support that is evidence based, culturally appropriate, and tailored to their needs. The values, beliefs, and individual needs of each woman and their family should be sought, and the final decision about the care and treatment options chosen by the woman should be respected.