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Background. The COVID-19 pandemic led to decreased physical activity, as well as increased stress, especially for pregnant women. Exercise is effective for decreasing stress and improving overall maternal and infant health. To date, research has not determined whether an at-home exercise program during pregnancy elicits similar results to in-person exercise.

Objective. To examine the effect of in-person vs at-home moderate-intensity exercise training during pregnancy on maternal cardiovascular and birth outcomes during the COVID-19 pandemic.

Methods. Pregnant women were recruited between 13-16 weeks’ gestation and randomized to either an exercise or control group. No control subjects were included in this analysis; exercisers were asked to complete at least 50-minutes of moderate-intensity activity 3 times each week either in-person (n=20) or at-home (n-17). Both groups were provided individualized exercise prescriptions including a 5-minute warm-up, 50-minutes of exercise related to group allocation, and a cool-down period. Maternal resting heart rate and blood pressure (BP) were recorded at 16- and 36-weeks' gestation. Gestational weight gain and birth outcomes were obtained via electronic health record at delivery.

Results. From enrollment to late pregnancy, at-home exercisers have significant increases in systolic and diastolic BP (SBP and DBP, p<0.001 and 0.0003, respectively) whereas the in-person group did not (p=0.30 and 0.78, respectively). In-person exercisers had lower SBP and DBP in late pregnancy (p=0.04 and 0.01, respectively) relative to at-home exercisers. At-home exercise was correlated with higher late pregnancy SBP (r=-0.34, p=0.04), DBP (r=-0.42,p=0.01), and SBP change (r=-0.496, p=0.002). Group allocation was a predictor for late pregnancy DBP (p=0.007) and SBP change (0.036). There were no differences in infant birth outcomes.

Conclusion. Supervised in-person exercise training with the proper precautions has similar birth outcomes and may be more beneficial for maternal cardiovascular health relative to at-home training.