Physical Activity During Pregnancy: Physiological Considerations and Practical Guidelines

Main Article Content

Ron Mor, PhD Izhar Ben Shlomo, MD

Abstract

Physical activity is a crucial element in preventing and coping with several chronic conditions. Many women become aware of their health issues as they plan pregnancy or become pregnant and consult their physician regarding limitations and recommendations in this situation. This review intends to endow the consulting general practitioner and obstetrician, as well as midwives with the background knowledge for this encounter. It details the physiological changes of pregnancy with regards to physical activity and deals with the range of allowed activities and the major risk groups who should be given special concern. In general, the best judge of a woman's ability to perform physical activity is her subjective feeling of appropriateness of a given effort.

Article Details

How to Cite
MOR, Ron; SHLOMO, Izhar Ben. Physical Activity During Pregnancy: Physiological Considerations and Practical Guidelines. Medical Research Archives, [S.l.], v. 10, n. 4, apr. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2753>. Date accessed: 03 dec. 2022. doi: https://doi.org/10.18103/mra.v10i4.2753.
Section
Research Articles

References

1. American College of Sports Medicine (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, muscuskeletal, and fitnes in appeentaly healthy adults: Guidance for prescribing exercise. Position Stand. Med Sci Sports Exerc. Jul;43(7):1334-54-9. DOI: 10.1249/MSS.0b013e318213fefb
2. Dipietro L, Evenson KR, Blaoodgood B, Sprow K, Troiano RP, Piercy KL, Vaux-Bjerke A, Powell KE; 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE. Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review. Med Sci Sports Exerc. 2019 Jun;51(6):1292-1302.
3. Osol G, Ko NL, Mandalà M .Plasticity of the Maternal Vasculature During Pregnancy. Annu Rev Physiol. 2019 Feb 10;81:89-111.
4. Artal R & O'Toole M, Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med, 2003; 37: p. 6-12; discussion 12.
5. Hytten F, Chamberlain G. Clinical Physiology in Obstetrics. Oxford: Blackwell Scientific Publications; 1991
6. Brenner IK, Wolfe LA, Monqa M & al, Physical conditioning effects on fetal heart rate responses to graded maternal exercise. Med Sci Sports Exerc, 1999;31:792-9.
7. Bergmann A, Zygmunt M & Clapp JF, 3rd, Running throughout pregnancy: effect on placental villous vascular volume and cell proliferation. Placenta, 2004; 25: 694-8.
8. Brown W, The benefits of physical activity during pregnancy. J Sci Med Sport, 2002;5:37-45.
9. Soultanakis-Aligianni HN, Thermoregulation during exercise in pregnancy. Clin Obstet Gynecol, 2003;46:442-55.
10. Larsson L & Lindqvist PG, Low-impact exercise during pregnancy--a study of safety. Acta Obstet Gynecol Scand, 2005;84:34-8
11. Lindqvist PG, Masal K, Merio J & al, Thermal response to submaximal exercise before, during and after pregnancy: a longitudinal study. J Matern Fetal Neonatal Med, 2003;13:152-6.
12. Ravanelli N, Casasola W, English T, Edwards KM, Jay O. Heat stress and fetal risk. Environmental limits for exercise and passive heat stress during pregnancy: a systematic review with best evidence synthesis. Br J Sports Med. 2019 Jul;53(13):799-805.
13. Smallcombe JW, Puhenthirar A, Casasola W, Inoue DS, Chaseling GK, Ravanelli N, Edwards KM, Jay O. Thermoregulation During Pregnancy: a Controlled Trial Investigating the Risk of Maternal Hyperthermia During Exercise in the Heat. Sports Med. 2021 Dec;51(12):2655-2664.
14. Weissgerber TL l,Wolfe LA, Hopkins WG & al, Serial respiratory adaptations and an alternate hypothesis of respiratory control in human pregnancy. Respir Physiol Neurobiol, 2006; 153:39-53.
15. Artal R, Rutheford S, Romen Y &, al, , Fetal heart rate responses to maternal exercise. Am J Obstet Gynecol, 1986; 155:729-33.
16. McAuley SE, Jensen D, McGrath MJ & al, Effects of human pregnancy and aerobic conditioning on alveolar gas exchange during exercise. Can J Physiol Pharmacol, 2005; 83:625-33.
17. Liu J, Lee I, Feng H-Z et al. Aerobic exercise preconception and during pregnancy enhances oxidative capacity in the hindlimb muscles of mice offspring. J Strength Cond Res 2018; 32: 1391–1403
18. Wolfe LA & Weissgerber TL, Clinical physiology of exercise in pregnancy: a literature review. J Obstet Gynaecol Can, 2003;25:473-83.
19. Clapp JF , 3rd, The effects of maternal exercise on fetal oxygenation and feto-placental growth. Eur J Obstet Gynecol Reprod Biol, 2003; 110 (Suppl 1): p. S80-5.
20. Petrov Fieril K, Glantz A, Fagevik Olsen M. The efficacy of moderate-to-vigorous resistance exercise during pregnancy: a randomized controlled trial. Acta Obstet Gynecol Scand. 2015 Jan;94(1):35-42
21. Practice ACO, ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol, 2002;99:171-3.
22. Impact of physical activity during pregnancy and postpartum on chronic disease risk. Med Sci Sports Exerc, 2006. 38(5): p. 989-1006.
23. Duncombe D, Skouteirs H, Wertheim EH & al, Vigorous exercise and birth outcomes in a sample of recreational exercisers: a prospective study across pregnancy. Aust N Z J Obstet Gynaecol, 2006;46:288-92.
24. Borg-Stein JP, Fogelman DJ & Ackerman KE, Exercise, sports participation, and musculoskeletal disorders of pregnancy and postpartum. Semin Neurol, 2011; 31:413-22.
25. Guillemette L, Hay JL, Kehler DS et al. Exercise in pregnancy and children's cardiometabolic risk factors: A systematic review and meta-analysis. Sports Med Open 2018; 4: 35. doi:10.1186/ s40798-018-0148-x
26. Perales M, Santos-Lozano A, Ruiz JR, Lucia A, Barakat R. Benefits of aerobic or resistance training during pregnancy on maternal health and perinatal outcomes: A systematic review. Early Hum Dev. 2016 Mar;94:43-8
27. Perales M, Valenzuela PL, Barakat R, Alejo LB, Cordero Y, Peláez M, Lucia A. Obesity can offset the cardiometabolic benefits of gestational exercise. Int J Obes (Lond). 2021 Feb;45(2):342-347.
28. Barakat R, Perales M. Resistance Exercise in Pregnancy and Outcome. Clin Obstet Gynecol. 2016 Sep;59(3):591-9.
29. Hui Wang, Ninghua Li, Tawanda Chivese, Mahmoud Werfalli, Hong Sun, Lili Yuen, Cecilia Ambrosius Hoegfeldt, Camille Elise Powe, Jincy Immanuel, Suvi Karuranga, Hema Divakar, NAomi Levitt, Changping Li, David Simmons, Xilin Yang. IDF Diabetes Atlas Committee Hyperglycaemia in Pregnancy Special Interest Group IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's Criteria. Diabetes Res Clin Pract. 2022 Jan;183:109050.
30. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, Song X, Ren Y, Shan PF .Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020 Sep 8;10(1):14790.
31. Dempsey JC, Butler CL, Sorensen TK & al, A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus. Diabetes Res Clin Pract, 2004;66:203-15.
32. de Barros MC, Lopes MA, Francisco RP & al, Resistance exercise and glycemic control in women with gestational diabetes mellitus. Am J Obstet Gynecol, 2010;203:556 e1-6.
33. Barakat R, Pelaez M, Lopez C & al, Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial. Br J Sports Med, 2013;47:630-6.
34. Westcott WL, Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep, 2012;11:209-16.
35. Damm P, Breitowicz B & Hegaard H, Exercise, pregnancy, and insulin sensitivity--what is new? Appl Physiol Nutr Metab, 2007;32:537-40.
36. Liu J, Laditka JN, Mayer-Davis EJ & al, Does physical activity during pregnancy reduce the risk of gestational diabetes among previously inactive women? Birth, 2008; 35:188-95.
37. Weissgerber TL, Wolfe LA, Davies GA & al, Exercise in the prevention and treatment of maternal-fetal disease: a review of the literature. Appl Physiol Nutr Metab, 2006;31:661-74.
38. Flack KD, Davy KP, Hulver MW & al, Aging, resistance training, and diabetes prevention. J Aging Res, 2010;2011:127315.
39. Witvrouwen I, Mannaerts D, Van Berendoncks AM, Jacquemyn Y, Van Craenenbroeck EM. The Effect of Exercise Training During Pregnancy to Improve Maternal Vascular Health: Focus on Gestational Hypertensive Disorders. Front Physiol. 2020 May 8;11:450.
40. Arvizu M, Minguez-Alarcon L, Stuart JJ, Mitsunami M, Rosner B, Rich-Edwards JW, Chavarro JE. Physical activity before pregnancy and the risk of hypertensive disorders of pregnancy. Am J Obstet Gynecol MFM. 2021 Dec 18;4(2):100556.
41. Davenport MH, Ruchat SM, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Skow RJ, Meah VL, Riske L, Sobierajski F, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Adamo KB, Davies GA, Barakat R, Mottola MF. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med. 2018 Nov;52(21):1367-1375.
42. Reilly ET, Freeman RM, Waterfield MR & al, Prevention of postpartum stress incontinence in primigravidae with increased bladder neck mobility: a randomised controlled trial of antenatal pelvic floor exercises. BJOG, 2002;109:68-76.
43. de Oliveira C, Lopes MA, Cala longo e Pereira L & al, Effects of pelvic floor muscle training during pregnancy. Clinics (Sao Paulo), 2007; 62:439-46.
44. Practice ACO, ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol, 2002;99:171-3.