2019 Canadian Guideline for Physical Activity throughout Pregnancy

2019 Canadian Guideline for Physical Activity throughout Pregnancy

New evidence-based guideline outlines the right amount of physical activity women should get throughout pregnancy to promote maternal, fetal, and neonatal health.


Research shows the health benefits and safety of being active throughout pregnancy for both mother and baby. Physical activity is now seen as a critical part of a healthy pregnancy. Following the guideline can reduce the risk of pregnancy-related illnesses such as depression by at least 25%, and the risk of developing gestational diabetes, high blood pressure and preeclampsia by 40%.


Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week over a minimum of three days per week; however, being active in a variety of ways every day is encouraged.

Preamble

These Guidelines provide evidence-based recommendations regarding physical activity throughout pregnancy in the promotion of maternal, fetal and neonatal health. In the absence of contraindications (see next page for a detailed list), following these Guidelines is associated with: 1) fewer newborn complications (i.e., large for gestational age); and 2) maternal health benefits (i.e., decreased risk of preeclampsia, gestational hypertension, gestational diabetes, caesarean section, instrumental delivery, urinary incontinence, excessive gestational weight gain, and depression; improved blood glucose; decreased total gestational weight gain; and decreased severity of depressive symptoms and lumbopelvic pain).


Physical activity is not associated with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabour rupture of membranes, neonatal hypoglycemia, low birth weight, birth defects, induction of labour, or birth complications. In general, more physical activity (frequency, duration and/or volume) is associated with greater benefits. However, evidence was not identified regarding the safety or additional benefit of exercising at levels significantly above the recommendations. Prenatal physical activity should be considered a front-line therapy for reducing the risk of pregnancy complications, and enhancing maternal physical and mental health.


For pregnant women not currently meeting these Guidelines, a progressive adjustment toward them is recommended. Previously active women may continue physical activity throughout pregnancy. Women may need to modify physical activity as pregnancy progresses. There may be periods when following the guidelines are not possible due to fatigue and/or discomforts of pregnancy; women are encouraged to do what they can and to return to following the recommendations when they are able.


These Guidelines were informed by an extensive systematic review of the literature, expert opinion, end-user consultation and considerations of feasibility, acceptability, costs and equity.

Recommendations

The specific recommendations in the 2019 Canadian Guideline for Physical Activity throughout Pregnancy are provided below.

1
Recommendation 1

All women without contraindication should be physically active throughout pregnancy.

Specific subgroups were examined:

  • Women who were previously inactive.
  • Women diagnosed with gestational diabetes mellitus.
  • Women categorized as overweight or obese (pre-pregnancy body mass index ≥ 25 kg/m2).
2
Recommendation 2

Pregnant women should accumulate at least 150 minutes of moderate-intensity physical activity each week to achieve clinically meaningful health benefits and reductions in pregnancy complications.
3
Recommendation 3

Physical activity should be accumulated over a minimum of three days per week; however, being active every day is encouraged.
4
Recommendation 4
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.
5
Recommendation 5
Pelvic 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.
6
Recommendation 6
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.

Contraindications

All pregnant women can participate in physical activity throughout pregnancy with the exception of those who have contraindications (listed below). Women with absolute contraindications may continue their usual activities of daily living but should not participate in more strenuous activities. Women with relative contraindications should discuss the advantages and disadvantages of moderate-to-vigorous intensity physical activity with their obstetric care provider prior to participation.

Absolute contraindications to 
exercise are the following:
  • ruptured membranes,
  • premature labour,
  • unexplained persistent vaginal bleeding,
  • placenta previa after 28 weeks gestation,
  • preeclampsia,
  • incompetent cervix,
  • intrauterine growth restriction,
  • high-order multiple pregnancy (e.g., triplets),
  • uncontrolled Type I diabetes,
  • uncontrolled hypertension,
  • uncontrolled thyroid disease,
  • other serious cardiovascular, respiratory or systemic disorder.
Relative contraindications to 
exercise are the following:
  • recurrent pregnancy loss,
  • gestational hypertension,
  • a history of spontaneous preterm birth,
  • mild/moderate cardiovascular or respiratory disease,
  • symptomatic anemia,
  • malnutrition,
  • eating disorder,
  • twin pregnancy after the 28th week,
  • other significant medical conditions.
Download the Guideline

Summary

The new Clinical Practice Guideline development committee was composed of representatives from the Society of Obstetricians and Gynecologists of Canada, Canadian Society for Exercise Physiology, University of Alberta, Western University, and Université du Québec à Trois-Rivières.

Twelve systematic reviews of over 25,000 related studies were conducted to produce the updated, evidence-based guidelines over a three-year span. The consensus panel involved researchers from the University of Alberta, Western University, Université du Québec à Trois-Rivières, Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, and La Universidad Politécnica de Madrid; representatives from Society of Obstetricians and Gynecologists of Canada, Canadian Society for Exercise Physiology, Canadian Academy of Sports Medicine, Exercise is Medicine Canada, College of Family Physicians of Canada, Canadian Association of Midwives, Middlesex-London Health Unit.


The Joint SOGC/CSEP Clinical Practice Guideline has been endorsed by:

  • Alberta Health Services – Healthy Families and Children
  • Canadian Academy of Sport and Exercise Medicine 
  • Canadian Association of Midwives
  • 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)
 

Thank you to Canadian Institutes of Health Research for their support and funding of this research.