Physical Activity
in Pregnancy
(VERSION 1)
Professional Briefing Sheet for
Community Physical Activity
Providers
These guidelines are for professionals working or providing physical activity, sport or
active recreation services to pregnant and postnatal women. These guidelines offer basic
advice/guidance and are not designed to refer mothers to specific programmes.
These guidelines provide general advice for professionals when handling enquires from healthy
pregnant and postnatal women regarding participation in activity.
References or adapted from
Bredin, S.S.D., Foulds, H.J.A., Burr, J.F. & Charlesworth, S.A. (2013). Risk assessment for physical activity and exercise clearance: in pregnant women without
contraindications. Canadian Family physician, Volume: 59, Number: 5, Pages: 515.
Get Active Your Way, Every Day! NHS Health Scotland.
Healthy Pregnant or Postpartum Women. Centers for Disease Control and Prevention
Healthy Weight Management For Women Before, During & After Pregnancy. NHS Bath and North East Somerset / Bath & North East Somerset Council.
Josefsson, A. Bø, K. (2010). Physical Activity in the Prevention and Treatment of Disease. (2010). Professional Associations for Physical Activity, Sweden. ISBN:
978-91-7257-715-2
Lewis, E. (2014). Exercise in pregnancy. The Royal Australian College of General Practitioners. Pages: 541-542.
Nascimento, S.L. Surita, F.G. and Cecatti, J.G. (2012).Physical exercise during pregnancy: a systematic review. Obstetrics & Gynecology. Volume 24 - Issue 6 - p
387–394
NHS Choices. (2013). What is Tai Chi?
NHS Choices – Your Health, Your Choice. Exercise in pregnancy.
NHS Start for Life – Keeping Active
Royal College of Obstetricians and Gynaecologists. (2006). Recreational exercise and pregnancy
Royal Berkshire NHS Foundation Trust. (2014). Pregnancy-related pelvic girdle pain (PGP): formerly known as symphysis pubis dysfunction (SPD)
Royal College of Obstetricians and Gynaecologists. (2006). Statement number 4: Exercise in Pregnancy
Royal Surrey County Hospital NHS Foundation Trust. (2012).Physiotherapy Department Pelvic Girdle Pain incorporating Symphysis Patient information leaflet.
Schoenfeld, B. (2011). Resistance Training During Pregnancy: Safe and Effective Program Design. Strength and Conditioning Journal. Volume: 33, Number: 5
Start Active, Stay Active. (2011). A report on physical activity for health from the four home countries’ Chief Medical Officers. UK Department of
Health.
Ulbricht, C. Basch, E. Bent, S. Chao, W. Costa, D. Che, W-D, Lee, D. Liebowitz, R. Shan, H. Sollars, D. Tanquay-Colucci, S. Weissner, W. (2010). An Evidenced based
Review of Qi Gong by the Natural Standard Research Collaboration. Volume: 5, Number: 5, Pages: 7-15. 2008
Wright, M. Sambrook, J. (2013). Pregnancy and Physical Activity. Patient
Physical Activity Guidelines for Americans. (2008). U.S. Department of Health and Human Services.
For women who were inactive before pregnancy, have a high risk pregnancy or have any concerns or
a pre-existing medical condition (e.g. BMI > 40) it is strongly recommended that the mother speaks
to a health professional before starting an activity/exercise programme. It may not be required to
avoid physical activity and exercise altogether, but this decision should be made only by a trained
health professional in discussion with the women. Josefsson & Bø (2010) provide a helpful summary on the
effects of physical activity on conditions associated with pregnancy (see references)
1. Is physical activity safe during pregnancy?
2. What are the health benefits?
Being physically active regularly at moderate intensity (e.g. brisk
walking) when pregnant is a very low risk activity and not dangerous
for the baby. Strength training and conditioning can be safe and
beneficial to health. Stomach-strengthening activities, pelvic tilts
exercises and pelvic floor exercises can all contribute to muscle and
joint strengthening, improved circulation, reduced backache, and
improved wellbeing. (NHS Choices Website - Exercise in pregnancy has
a list of recommended activities). Controlled movements for example
weight bearing exercises are beneficial although if load causes strain
or grunt when lifting then it is too heavy. Seek advice on correct
technique. Women wishing to commence a strength/resistance training
programme should first seek medical clearance.
•
Improved mood throughout the postpartum period
•
Reduce stress, anxiety and fatigue and increased self-esteem
•
Helps to maintain a healthy weight (alongside calorie reduction)
•
Reduced risk of miscarriage
•
Coping with labour and getting back into shape after the birth
•
Reduced risk of incontinence (due to exercising pelvic floor
muscles)
For already healthy pregnant or postnatal woman, physical activity
is beneficial for their overall health and wellbeing. Women should be
advised to retain their regular levels of physical activity or exercise for
as long as they feel comfortable. Emphasis should be on maintaining
a reasonable physical activity (fitness) level during pregnancy not
improving or optimising.
Physical activity does not increase chances of:
•
Low-birth weight
•
Early delivery
•
Early pregnancy loss
•
Negative impact on breast milk volume/composition
3. How much physical activity should I be
doing?
The UK guidelines recommend a minimum of 150 minutes each week
of moderate intensity physical activity (eg brisk walk)
Physical activity should be spread out across the week with 10 minutes
or more counting towards recommended levels.
4. How active should
pregnant women be?
Table 1 below provides definitions for key terms within this paper.
Table 1: Key Terms with definitions
(from Start Active, Stay Active, 2011)
The UK guidelines recommend
a minimum of 150 minutes
each week of moderate
intensity physical activity (eg
brisk walk) or 75 minutes
vigorous for adults 18+.
For pregnant women, the
guideline differs.
Term
Moderate intensity
For low risk pregnancies,
women active
before pregnancy
can continue to
participate in
moderate to vigorous
physical activity 4
times a week for 30
minutes (45 minutes
max) during pregnancy.
Women inactive before
pregnancy (sitting) can undertake mild or moderate activity. For those
sedentary/inactive, 15 minutes of activity 3 times per week should aim
to increase to 30 minutes on 4 days of the week. Exercise to exhaustion
is not recommended at any time regardless of activity status. Again,
women inactive or with a high risk pregnancy, pre-existing medical
condition or concern must speak to a health professional before
starting an activity/exercise programme
As a general rule, women should be able to hold a conversation as
they exercise when pregnant. If they become breathless as they talk,
then they’re probably exercising too strenuously. Women need to try
to keep active on a daily basis: half an hour of walking each day can
be enough, but if they can’t manage that, any amount is better than
nothing.
Depending on the woman’s activity level, moderately intense physical
activity will differ between people. The talk test (figure 1) is a helpful
method to measure personal effort. On an effort scale of 0–10,
moderate intensity would be about level 5–6 when they need to take
a few extra breaths while chatting and walking. If they are unable to
chat without taking big breaths in between then they are at about level
7–8, this would be classified as vigorous (or strenuous) and indicates
they may be exercising too hard during pregnancy. This corresponds to
12-14 on the Borg Scale of Perceived Exertion (somewhat hard). The
Borg scale accesses intensity of exercise through a continuing ranging
from 6-20. The Borg Scale is a useful measure as heart rate is elevated
during pregnancy therefore pulse level is not always the best means to
measure intensity.
For more information on intensity of activity/exercise including heart
rate monitoring please see the Royal College of Obstetricians and
Gynaecologists information cited in the reference section. This resource
is designed to assist health care professionals to discuss/develop
activity/exercise programmes. Therefore, professionals wishing to refer
into exercise or design a programme are advised to review/consider
this resource.
Figure 1: Talk Test Diagram
Measuring physical activity effort level
0
1
2
3
4
Moderate Vigorous
5
6
7
8
9
10
Muscle
strengthening
activity
Physical activity
Definition
A moderate intensity physical activity
requires an amount of effort and noticeably
accelerates the heart rate, e.g. brisk walking,
housework and domestic chores. On an
absolute scale, moderate intensity is defined
as physical activity that is between 3 and 6
METs.
Physical activity that increases skeletal
muscle strength, power, endurance and mass.
Any bodily movement produced by skeletal
muscles that requires energy expenditure.
Sedentary behaviour Activities that do not increase energy
expenditure much above resting levels.
There is a difference between sedentary and
light physical activities. Activities considered
sedentary include sitting, lying down and
sleeping because they do not require any
muscle recruitment. Associated activities,
such as watching TV and reading, are also in
the sedentary category.
Vigorous intensity
An activity that requires a large amount
of effort, causes rapid breathing and a
substantial increase in heart rate, e.g.
running and climbing briskly up a hill. On an
absolute scale, vigorous intensity is defined
as physical activity that is above 6 METs.
5. Safety tips for exercising when pregnant
6. Top tips
•
If you are in any doubt about the person’s ability to participate,
signpost to the maternity services (e.g. midwife) team, GP or
healthcare provider
•
Ensure a warm up and cool down before and after exercise is
complete
•
Avoid strenuous exercise in hot weather
•
Physical activity does not have to be strenuous to be beneficial.
Walking is a simple, free, safe and healthy means to gradually
build more physically activity into our daily routine
•
Drink plenty of water and other fluids
•
Wear layered clothing to assist heat loss, a supportive bra and
appropriate footwear
•
Ensure the woman informs the instructor that she is pregnant
•
Ensure the woman is directed to a class with appropriately trained
coach/instructor
•
Exercise should be 45 minutes or less
•
Eat healthy foods during pregnancy for energy for mother and baby
•
Extra caution is advised when cycling.
•
Recommend against exercising so hard that they become
exhausted
•
Recommend against strenuous exercise if they were inactive
before pregnancy
•
Women may need to slow down as their pregnancy progresses or
as the maternity team advises them
•
If women are taking part in a class run by an instructor, always
check the instructor has the appropriate qualification to teach the
class safely. They should advise the instructor of the pregnancy
and ask if any modifications are needed for any of the exercises.
This information will be treated sensitively
•
•
Women with unusual symptoms during pregnancy should stop
and speak to their healthcare provider. This may include dizziness
or feeling faint, headache, bleeding, pain/swelling in legs, amniotic
fluid leakage, pain particularly in back/chest/abdomen/pelvic girdle
or pubic area, weakness in muscles and less movement of the
baby. If the symptom starts during exercise, gradually cool down
to a stop by walking slowly
Pelvic girdle pain that is pregnancy-related is common as
muscles are placed under greater strain. Being physically active
is beneficial but avoid any activity which increases pelvic girdle
pain or causes discomfort. Activities which may be beneficial or
comfortable include:
7. Exercises to avoid in pregnancy
The following activities must not be recommended to pregnant mothers:
•
Do not lie flat on back especially after 16 weeks. This avoids the
weight of the bump pressing on the main blood vessel bringing
blood back to the heart and this can make them feel faint
•
Contact sports where there’s a risk of being hit
•
Sports or activities with a risk of falling (e.g. gymnastics)
•
Scuba diving as the baby has no protection against decompression
sickness and gas embolism (gas bubbles in the bloodstream)
•
Horse riding
•
Exercise at heights over 2,500m above sea level until they have
acclimatised: this is because the woman and baby are at risk of
altitude sickness
•
Activities that avoid rapid/sudden changes in direction
Hot yoga - the increased risk of neural tube defects and other
foetus malformations exposed to excessive heat.
Water temperature - Pregnant women should not exercise in
water over 32ºC. Avoid hydrotherapy pools over 35ºC and hot tubs
are not recommended
•
Walking (gentle) on level ground with good fitting shoes can
be a good activity
•
Athletes and athletic performance?
•
•
Athletes can continue to train for competitions but will require supervision
by an obstetrician with specialist knowledge and expertise from a
qualified instructor. For advice on additional hydration and nutrition. Elite
athletes should prepare for reduction in peak fitness and performance.
Swimming can be beneficial but avoid breaststroke as leg
movements can stress pelvic joints. Back stroke/front crawl
strokes may be easier or breaststroke arms and paddle legs
•
Gentle core stability exercises (gentle) drawing in the lower
abdominals and drawing up the pelvic floor muscles
•
Gentle exercising on a gym ball or
sitting and rocking
•
Avoid head lifts and twisting
crunches as exercises if they have
weak abdominals as this may
weaken these muscles further
•
Exercises in supine position (lying
face upward) should be avoided
during the second half of pregnancy
to prevent hypotension and valsalva
maneuverer
•
There are health benefits of participating
in Tai Chi and Qui Gong, however please
seek advice from a GP before starting a
programme