Exercise in pregnancy

Abstract

Key content The physiology of pregnancy and responses to exercise. The benefits of exercise in pregnancy. The potential harms related to exercise in pregnancy. Guidelines and recommendations for exercise in pregnancy. Learning objectives To understand the interaction between the physiology of exercise and pregnancy. To be able to counsel women regarding the benefits and harms of exercise in pregnancy. To recognise longer term benefits of exercise on maternal and fetal health. Ethical issues Consider the variable national recommendations and their impact on pregnant women. Acknowledge the lack of specific research on intensity and nature of exercise.

The Effect of Exercise Training During Pregnancy to Improve Maternal Vascular Health: Focus on Gestational Hypertensive Disorders

“…The same is true for the concerns regarding exercise and low birth weight: maternal exercise was not associated with low birth weight or Apgar score at delivery (Davenport et al, 2018a). The normalization of maternal blood glucose, decrease in insulin resistance and increased placental functional capacity and nutrient delivery are suggested mechanisms to explain the beneficial effect of exercise on birth weight (Clapp, 2003;Kuhrt et al, 2015).…”

“…However, evidence on resistance training is scarce and exercise with heavy loads is discommended (Savvaki et al, 2018). Most recreational exercise is safe, but sports that may cause abdominal trauma, falls or excessive joint stress and scuba diving should be avoided (Kuhrt et al, 2015;Bø et al, 2016;Savvaki et al, 2018).…”

“…Whereas the guidelines generally recommend 30 min of moderate exercise two to four times per week, 85% of pregnant women are exercising below these levels (Evenson and Wen, 2010). The most frequent barriers are fatigue, lack of time and pregnancy discomforts, but also safety concerns such as low birth weight, preterm labor and inducing fetal bradycardia could withhold pregnant women and health practitioners to prescribe the recommended amount of physical exercise (Kuhrt et al, 2015;Coll et al, 2017;Harrison et al, 2018;Witvrouwen et al, 2019b). Adequate knowledge on the physiological effects of exercise training in healthy pregnancy should help to overcome these barriers as pregnancy is a unique window of opportunity to improve health outcomes for the mother and also the future generations (Kuhrt et al, 2015).…”

“…Nevertheless, a significant decrease in mean uterine artery blood flow and fetal bradycardia has only been shown in Olympic level athletes exercising at more than 90% of the maximal maternal heart rate (Salvesen et al, 2011). Moreover, it has been shown that regular exercise improves both maternal cardiovascular adaptations and placental function to maintain sufficient fetal oxygenation and growth and does not adversely affect fetal heart rate (Clapp, 2003;Kuhrt et al, 2015).…”

“…Worldwide guidelines recommend aerobic training during pregnancy from 60 to 150 min/week (Savvaki et al, 2018). Little is known about the number of women practicing this, but numbers as low as 15% have been cited (Kuhrt et al, 2015). Women who exercise as recommended have 30% less risk for developing gestational hypertensive disorders (GHD), including gestational hypertension (GH), characterized by hypertension initiating after the 20th pregnancy week and pre-eclampsia (PE) defined as hypertension and proteinuria after the 20th pregnancy week (Magro-Malosso et al, 2017;Davenport et al, 2018b).…”