The new Canadian Guideline for Physical Activity throughout Pregnancy was released this year, and it represents a shift in our view of prenatal physical activity as a recommended behavior to improve quality of life, to a prescription for physical activity to reduce pregnancy complications and optimize health.
A high-level summary of the recommendations is:
“All women without contraindication should be physically active throughout pregnancy – accumulating at least 150 min. of moderate-intensity physical activity over at least 3 days each week”
The guideline provides evidence-based recommendations regarding physical activity throughout pregnancy to promote maternal, fetal, and neonatal health.
We know that regular physical activity is associated with substantial health benefits. However, uncertainly among some pregnant women and clinicians as to whether prenatal physical activity may increase risks has served as a barrier to being active. In fact, we know that only 15% pregnant women will perform the recommended 150 minutes of moderate-intensity physical activity during their pregnancy. Physical activity is not associated with miscarriage, stillbirth, preterm birth, birth defects, or birth complications.
The risks of not engaging in physical activity during pregnancy have also not been emphasized. Not engaging in physical activity from the first trimester increases risks of pregnancy complications (eg: gestational diabetes, pre-eclampsia, gestational hypertension, depression). For pregnant women not currently meeting the recommendation, progressively increasing physical activity is recommended. There may be periods when following the guidelines is not possible due to nausea, fatigue, or discomforts of pregnancy. Even if pregnant women cannot meet the recommended level of activity, they should be encouraged to be as active as possible and to return to following the recommendations when they are able.
Following the recommendations in the guideline is associated with fewer newborn complications, as well as with maternal health benefits (eg: decreased risks of pre-elampsia, gestational diabetes, caesarean section, depression, lumbopelvic pain).
When I first told my pregnant wife about the new guideline, she quickly wanted to know if the authors were pregnant. So who wrote the guideline? Well the consensus panel consisted of researchers in the field of prenatal exercise, exercise professionals, and representatives from the the Society of Obstetricians and Gynaecologists of Canada (SOGC), the College of Family Physicians of Canada, the Canadian Association of Midwives, the Canadian Academy of Sport and Exercise Medicine, and Exercise is Medicine Canada.
- All women without contraindication should be physically active throughout pregnancy
- Pregnant women should accumulate at least 150 min of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications.
- Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged.
- Pregnant women should 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 (eg: 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.
- Pregnant women who experience light-headedness, nausea or feel unwell when they exercise flat on their back should modify their exercise position to avoid the supine position
All pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications.
Women with absolute contraindications (eg: ruptured membranes, premature labour, pre-emclampsia) may continue their usual activities of daily living but should not participate in more strenuous activities.
Women with relative contraindications (eg: gestational hypertension, symptomatic anaemia, recurrent pregnancy loss) should discuss the advantages and disadvantages of physical activity with their obstetric care provider.
If you believe that exercise may be contraindicated during your pregnancy, you should discuss this with your health care provider.
Some sport activities carry excess risk in pregnancy and are considered contraindicated.
- Avoid physical activity in excessive heat, especially with high humidity (eg: hot yoga)
- Avoid activities which involve physical contact or danger of falling (eg: non-stationary cycling, downhill skiing, ice hockey).
- Avoid scuba diving.
Evidence was not identified regarding the safety or benefit of exercising at levels significantly above the recommendations. As such, women considering competitive athletics or exercising at levels significantly above the recommended guidelines should speak with their health care provider. The Guideline Consensus Panel recommends high-intensity physical activity only in a monitored environment.
A warm-up and cool-down period should be included in any activity. Due to altered hormone levels during pregnancy, ligaments become relaxed and may impact the range of movement and affect risk of injury.
Dr. Stephen Konkle is a chiropractor in downtown Ottawa where he owns and operates Remedy Chiropracic & Sports Injury Centre. Dr. Konkle studied at Canadian Memorial Chiropractic College alongside Dr. Ramsackal.