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Sports Medicine Australia (SMA) 'Exercise in pregnancy and the postpartum period' Position Statement.

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EXERCISE IN PREGNANCY AND THE POSTPARTUM PERIOD Purpose of this statement The primary purpose of this document is to provide an evidence-based, best practice summary to assist Sports Medicine Australia (SMA) members [including: health professionals (e.g. general practitioners, sports doctors, sports physicians, physiotherapists, chiropractors, exercise physiologists, occupational therapists, podiatrists, sports scientists, psychologists, nurses, etc.); fitness professionals (e.g. fitness instructors, personal trainers, aqua instructors etc.)], others who are involved in sport (e.g. coaches, officials, administrators, journalists), and players and athletes themselves, to understand the benefits and risks of participation in physical activity/exercise in pregnancy and the postpartum period. This position statement is based on:  A review of the evidence from twelve systematic reviews and meta-analyses published since 2010. 1-12  A review of the findings of nine additional more recent narrative reviews of the evidence on exercise and pregnancy outcomes and recommendations, published since 2010. 13-21  A review of the information included in 11 statements on exercise and pregnancy from 9 countries, as summarised in two peer-reviewed summary papers. 22-23  Information included in six 'guidelines' or 'fact sheets' on exercise during pregnancy. 24-29  Information from the scientific reports on the Australian and US physical activity guidelines, and a WHO factsheet on obesity and overweight. 30-32
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
EXERCISE IN PREGNANCY AND THE
POSTPARTUM PERIOD
Purpose of this statement
The primary purpose of this document is to provide an evidence-based, best practice
summary to assist Sports Medicine Australia (SMA) members [including: health
professionals (e.g. general practitioners, sports doctors, sports physicians,
physiotherapists, chiropractors, exercise physiologists, occupational therapists, podiatrists,
sports scientists, psychologists, nurses, etc.); fitness professionals (e.g. fitness instructors,
personal trainers, aqua instructors etc.)], others who are involved in sport (e.g. coaches,
officials, administrators, journalists), and players and athletes themselves, to understand
the benefits and risks of participation in physical activity/exercise in pregnancy and the
postpartum period.
This position statement is based on:
A review of the evidence from twelve systematic reviews and meta-analyses
published since 2010.1-12
A review of the findings of nine additional more recent narrative reviews of
the evidence on exercise and pregnancy outcomes and recommendations,
published since 2010.13-21
A review of the information included in 11 statements on exercise and
pregnancy from 9 countries, as summarised in two peer-reviewed summary
papers.22-23
Information included in six ‘guidelines’ or ‘fact sheets’ on exercise during
pregnancy.24-29
Information from the scientific reports on the Australian and US physical
activity guidelines, and a WHO factsheet on obesity and overweight.30-32
Note: A number of high quality reviews of evidence were excluded from this review as they
examined physical activity/exercise and diet, not physical activity/exercise as an
independent variable.33-35
Definitions
The term ‘physical activity’ is used in this document to describe participation in activities such
as walking, cycling, swimming and jogging which are typically undertaken for leisure or
transport. The term ‘exercise’ is used to describe more structured forms of activity, including
sports and recreational activities, where the focus is usually on performance or competition.
In cases where there is no distinction in terms of the evidence review, the term ‘physical
activity/exercise’ is used.
Perspective
Reflecting a perception that exercise might be harmful to the mother and/or her unborn child,
pregnancy was once considered a time for rest, when women were advised to take it easy
and refrain from participating in physical activity/exercise. Despite the difficulties of
conducting carefully controlled randomised trials, this view is now challenged by a growing
body of systematic review level evidence.
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
Focus of this statement
This statement focuses on safe physical activity/exercise for healthy women who are free
of the medical and obstetric contraindications outlined in Section 6.
1. Summary
It is important that all pregnant women (inactive, active, sportswomen and athletes)
consult with their health care providers (which could include a GP, obstetrician,
midwife or physiotherapist) about physical activity/exercise during and after
pregnancy.
Evidence from twelve systematic reviews suggests that, for healthy women, physical
activity/exercise during pregnancy is safe and is associated with numerous benefits
to the mother and unborn child/foetus (Section 6).
International guidelines on exercise during pregnancy concur that there are
contraindications, signs and symptoms, which indicate that physical activity/exercise
is not recommended. SMA suggests that exercise professionals and health care
providers should be familiar with these (Section 7).
International guidelines also concur with the view that walking, jogging, cycling and
swimming (at moderate intensity), muscle strengthening exercises (including pelvic
floor exercises), water based exercise, and pregnancy-specific exercise classes are
safe for pregnant women. These guidelines also list activities/situations which should
be avoided (Section 8).
Evidence from systematic reviews also supports the view that returning to physical
activity/exercise in the post-partum period has benefits in terms of the mothers’
physical and mental health and wellbeing (Section 10).
2. Exercise during pregnancy for previously inactive women
Pregnant women who were inactive prior to pregnancy should be encouraged to be active
during pregnancy11, 14, 17-18, 29, commencing with low intensity activities such as walking or
swimming, and progressing to the lower end of the range recommended in the Australian,
Canadian and US national guidelines (i.e. 150 minutes per week or 30 minutes per day of
moderate intensity activity on most days).26, 29-32 Activity can initially be accumulated in short
(say 15 minute) bouts, building towards bouts of longer duration.11, 26, 29-31 Pregnant women
who were inactive prior to conception are advised to consult a health care provider before
commencing physical activity/exercise.
3. Exercise during pregnancy for previously active women
For healthy pregnant women who participated in physical activity/exercise prior to
pregnancy, and are experiencing an uncomplicated pregnancy, physical activity/exercise
can be continued throughout pregnancy, or until such time that it becomes uncomfortable
to do so.11, 14, 17-18, 21, 29
A typical ‘prescription’ for a moderate to vigorous intensity physical activity/exercise
program23, 29 that can be continued during healthy pregnancies (free of medical and/or
obstetric complications) is shown overleaf:
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
Aerobic activities:
Frequency: Daily.
Intensity: Intensity (12-14 on Borg rate of perceived exertion scale (RPE) perceived as
somewhat hard, can talk but not sing).
Time: Accumulate 150-300 mins (30-60 mins on most, if not all, days each week. Longer
duration (closer to 300 minutes, instead of 150 minutes/week) is associated with more
benefits i.e. reduced risk of excess weight gain and gestational diabetes.
Type: Brisk walking/running/jogging, cycling (stationary bike), swimming, aerobics etc.
As a general rule of thumb, count each minute of vigorous intensity exercise as two minutes
of moderate intensity exercise (i.e. 75 minutes of vigorous intensity exercise equates with
150 minutes of moderate-intensity exercise).30-31
Muscle strengthening exercise:
Frequency: 2 sessions per week.
Intensity: Sub-maximal intensity using own body weight, light weights and/or resistance
bands (exhale on effort).
Type: Work all large muscle groups (refer to PARmed-X for Pregnancy25 for specific
exercises).
Programming: 1 set of 12-15 repetitions of up to 8-10 exercises.17, 20, 28, 30-31
4. Exercise during pregnancy for the elite pregnant athlete
Exercise during pregnancy does not increase the risk of adverse pregnancy or birth
outcomes, not even for elite athletes.16-18 However, pregnant women who were very active
or elite athletes/sportswomen should have their physical activity/exercise regime
overseen and managed by an expert health care provider to ensure the safety and wellbeing
of the mother and her unborn child.17, 26, 29 This is particularly important in cases where the
foetus is small for gestational age. The PARmed-X for Pregnancy25 can be used to assist
health care providers in the exercise prescription process.
5. Exercise modifications during pregnancy
Most exercises/activities during pregnancy present minimal risk to the mother or the child.
However, some modifications to exercise techniques and/or programs may be required to
accommodate the anatomical and physiological changes which occur as pregnancy
progresses.29 In addition to their regular aerobic activity and muscle strengthening
exercises, all pregnant women are advised to do pelvic floor exercises.10, 12, 26
Pelvic floor exercises:
Pelvic floor exercises help to strengthen and improve the tone of the pelvic floor muscles,
which provide perineal support for the pelvic structures, the urethra, vagina and rectum.
There is strong evidence to suggest that women who do intensive, supervised pelvic floor
exercises during pregnancy may reduce the risk of urinary incontinence (leakage)
postpartum.10, 12, 26 These exercises involve repetitive contraction of the pelvic floor muscles
to build strength and muscle tone. The movement is a voluntary inward and upward
contraction of the pelvic floor. Specific advice should be sought from a physiotherapist,
nurse continence adviser, or midwife with qualifications and expertise in pelvic floor muscle
training. A typical ‘prescription’ for a pelvic floor exercise program 10, 12, 25 is shown below:
Frequency: At least 8-12 contractions 3 times per day, three to four times per week.
Intensity: Women should be encouraged to ‘contract maximally’ with an inward and upward
squeezing movement.
Time: Vary the duration of the ‘squeeze’ from 4 to 30 second holds; with a mixture of slow
and controlled, and fast and controlled contractions.
Type: Try sitting with weight forward (hands on knees), and also sitting upright, as this will
help to recruit all muscles, anterior (front) and posterior (back), involved in the squeeze
movement. These exercises can be done in a sitting, kneeling, standing, lying down or
standing with legs astride position.
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
6. Benefits of physical activity/exercise during pregnancy
There is strong evidence, from fifteen systematic reviews/meta-analyses, nine review
papers, and a narrative review of national exercise during pregnancy guidelines, to suggest
that the benefits of physical activity/exercise for pregnant women include:
Improved muscular strength and endurance.11, 17, 29
Improved cardiovascular function and physical fitness.1, 17, 21, 29
Decreased risk of pregnancy related complications such as pregnancy-induced
hypertension and pre-eclampsia.5, 9, 18, 29
Reduced back and pelvic pain.11, 16-17
Reduced fatigue, stress, anxiety and depression.4, 11, 21, 29
Decrease in excessive gestational weight gain and post-partum weight retention.13,
16, 18, 21, 29
Fewer delivery complications in women who are active during pregnancy.15, 21, 29
Prevention and management of urinary incontinence.10, 12
Note: Evidence on the role of physical activity/exercise in the prevention of gestational
diabetes is mixed. It is clear that women who gain more than the recommended amount of
weight during pregnancy are at increased risk of developing gestational diabetes. Although
many randomised controlled studies have shown that lifestyle intervention (involving both
physical activity and diet) can reduce the risk of gestational diabetes,2, 6-8, 11 systematic
reviews suggest that the effects of physical activity alone are currently unclear.34 Women
are advised therefore to follow both physical activity AND healthy eating guidelines to
reduce the risk of gestational diabetes.
7. Contraindications to physical activity/exercise during pregnancy23-24, 26-27, 29
Although no systematic level evidence exists, national physical activity guidelines from
around the world agree that in the following situations the risks of physical activity/exercise
are likely to outweigh the benefits. Pregnant women who experience any of the following
are advised not to exercise, and to seek medical advice:
Ruptured membranes.
Signs of preterm labour.
Hypertensive disorders of
pregnancy.
Incompetent cervix.
Growth restricted foetus.
High order multiple gestation
(>triplets).
Placenta praevia after 28th
week.
For women who have a history of any of the following, we recommend professional
collaboration between medical (e.g. obstetrician or midwife) and training (e.g.
coaches/trainers) professionals to ensure that women exercise with caution or at a low level,
provided they are asymptomatic at rest.
Previous spontaneous abortion.
Previous preterm birth.
Mild/moderate cardiovascular or
respiratory disorder.
Anaemia (Hb <100 g/L).
Malnutrition or eating disorder.
Twin pregnancy after 28th week.
Extreme overweight/obesity (BMI
>30).32
Intrauterine growth restriction in
current pregnancy.
Other significant medical conditions
(e.g. poorly controlled type 1
diabetes, hypertension,
hyperthyroidism etc).
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
Women who experience any of the following symptoms should seek advice from their ante-
natal care provider before continuing with their physical activity/exercise program.
Abdominal pain.
Amniotic fluid leakage.
Calf pain or swelling.
Chest pain/tightness/palpitations.
Decreased foetal movement.
Dizziness or presyncope.
Dyspnoea, before exertion.
Excessive fatigue.
Excessive shortness of breath.
Muscle weakness.
Pelvic pain.
Preterm labour.
Severe headaches.
Uterine contractions (premature and/or painful).
Vaginal bleeding.
8. Activities that are/are not recommended17, 23-24, 26-27, 29
Although no systematic level evidence exists, national guidelines concur that the following
activities are considered to be generally safe for pregnant women with an uncomplicated
pregnancy:
Walking, jogging, cycling and swimming (at moderate-intensity).
Muscle strengthening exercises, including pelvic floor exercises.
Water-based exercise.
Pregnancy specific exercise classes.
Activities which are characterised by the following are considered unsafe for pregnant
women and should be avoided:
Abdominal trauma or pressure (e.g. weight lifting).
Contact or collision (e.g. soccer, ice hockey, martial arts etc).
Hard projectile objects or striking implements (e.g. hockey, cricket, softball etc).
Falling (e.g. judo, skiing, skating, horse riding etc).
Extreme balance, coordination and agility (e.g. gymnastics, water skiing etc).
Significant changes in pressure (e.g. scuba diving, sky diving etc).
Heavy (greater than submaximal) lifting.
High intensity training at altitudes greater than 2000m.
Exercise in the supine position, or even motionless supine posture (e.g. in some yoga
positions) may cause hypotension in some women; for safety, avoid supine exercise
positions after 28 weeks’ gestation; some exercises can be adapted to lying on the side.
Specific activities listed above are examples only; participation in specific activities should be
discussed with the health care provider and should be reviewed as pregnancy progresses.
9. Additional recommendations23-24, 26-27
As for all exercise programmes, there is consensus (but not always scientific evidence) that
each session should incorporate applicable warm up and cool down activities, clothing should
be non-restrictive and made of ‘breathable’ fabric, shoes should be appropriate for the activity
and a supportive bra should be worn. Avoiding large increases in body temperature during
exercise is important. The following should be considered when planning exercise during
pregnancy:
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
Avoid hot and/or humid exercise environments and take care to remain well hydrated.
Stretching should be controlled and not ‘over-extended’ as joints and ligaments are
already loose due to the release of the hormone relaxin in preparation for birth.
Avoid wide squats, lunges or any unilateral leg exercises that place excessive shearing
forces on the pubic symphysis.
10. Resuming physical activity/exercise after pregnancy11, 22, 24, 26, 29
The postpartum period is defined as the time immediately after birth. There is no clearly
defined end to the post-partum period, but it is usually considered to be 6 to 26 weeks following
the birth. Many of the physical and physiological changes that occur during pregnancy will
persist for four to six weeks after delivery. SMA recommends that women seek guidance from
their health care provider before they begin or recommence their physical activity/exercise
regime, but in general all healthy women should aim (through gradual progression) to
accumulate 150-300 minutes of moderate-vigorous intensity aerobic exercise per week.
Return to high impact activities or those that cause high gravitational load on the pelvic floor
should occur gradually, and in consideration of recovery to any damage to the pelvic floor and
abdominal muscles, which will vary according to the mode of delivery.
There is systematic review level evidence to show that benefits of physical activity/exercise to
the mother after pregnancy include:
Improvements in emotional well-being.3-4, 13, 19
Reduced anxiety and depression.3-4, 19
Improved physical conditioning.13, 29
Reduced postpartum weight gain and faster return to pre-pregnancy weight.13, 21, 35
Postpartum physical activity/exercise and effects on breastfeeding
Moderate to vigorous intensity physical activity/exercise and sports will not negatively affect
breast milk volume, as long as there is appropriate food and fluid intake.24 , 26, 29 This type of
exercise or physical activity has also been shown not to affect the composition of breast milk
or infant growth. However, if babies appear to be unsettled after feeding immediately after
maternal exercise, mothers could feed their baby before exercise, postpone feeding to one
hour after physical activity/exercise, or express milk before exercising, so that it may be used
after the activity.24, 26 The caloric cost of breast feeding is estimated to be about 600 kcal/day.
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
Sports Medicine Australia would like to acknowledge the following for their valuable contributions
to this position statement.
Melanie Hayman BHMSc, MEd
PhD Candidate, APA Scholarship Recipient
School of Medical and Applied Sciences
2014/2015 CQ Medicare Local Healthy CQ Grant Recipient
CQUniversity Australia
Professor Wendy Brown BSc, GradDip (Phys Ed), MSc, PhD
Professor
School of Human Movement and Nutrition Sciences
Faculty of Health and Behavioural Sciences
University of Queensland
Dr Katia Ferrar BAppSc (Physio), BHlthSc (Hons), PhD
Lecturer
Alliance for Research in Exercise, Nutrition and Activity
School of Health Sciences
University of South Australia
Rosemary Marchese BAppSc (Physio), Certificate IV in Training and Assessment
Physiotherapist
Fitness and Health Vocational Educational Consultant
Right Way Fitness Industry Advisor for Service Skills Australia
Jon Tan BSc (Chiro), BChiro, ICCSP, Cert III/IV Fitness
Chiropractor, Personal Trainer
National Chairman – Sports Chiropractic Australia
SMA Position Statement Exercise in Pregnancy and the Postpartum Period updated 19/07/16
www.sma.org.au
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... Regular physical activity has a positive effect on the mind and body of pregnant women and on maternal and fetal outcomes, including a lower incidence of excessive gestational weight gain, postpartum weight retention, gestational diabetes mellitus, preeclampsia, preterm or Cesarean birth, and having an infant with low birth weight. [1][2][3][4][5][6][7] Despite these numerous benefits, many women who are pregnant become less physically active or stop exercising altogether. 8 Possible reasons for the decreased levels of physical activity during pregnancy are that only half of women receive exercise guidance during prenatal care meetings and 15% report being told to stop exercising by their prenatal care team. ...
... Of the 12 qualifying articles, 3-7,17-19,21-24 four professional societies reported recommendations as position statements, 6,18,21,22 one was a consensus statement, 7 one was a committee opinion, 3 two were handouts/ packets for clinical utilization, 4,23 and four were guidelines. 5,17,19,24 Six reports were published as exercise guidelines during pregnancy, 4,6,17,18,22,23 four reports were published as physical activity guidelines, 7,19,21,24 and two reports were published as both exercise and physical activity guidelines during pregnancy. ...
... Of the 12 qualifying articles, 3-7,17-19,21-24 four professional societies reported recommendations as position statements, 6,18,21,22 one was a consensus statement, 7 one was a committee opinion, 3 two were handouts/ packets for clinical utilization, 4,23 and four were guidelines. 5,17,19,24 Six reports were published as exercise guidelines during pregnancy, 4,6,17,18,22,23 four reports were published as physical activity guidelines, 7,19,21,24 and two reports were published as both exercise and physical activity guidelines during pregnancy. 3,5 Other information included in the qualifying statements were the benefits of physical activity during pregnancy, [3][4][5][6][7][17][18][19]21,22,24 preparticipation health screening, 5,7,17,22,23 contraindications to exercise, [4][5][6][7]17,18,21,23 activities to avoid, [3][4][5][6][7][17][18][19][21][22][23][24] and special considerations [3][4][5][6][7][17][18][19][21][22][23][24] for exercising while pregnant. ...
Article
Background: Exercise in pregnancy favorably affects maternal and fetal outcomes, yet only 50% of women receive exercise guidance during prenatal care and 15% are told to stop exercising. Reasons for clinician reluctance to recommend exercise include safety concerns and ambiguity of recommendations. To better inform clinicians, this systematic review assembled a consensus exercise prescription (ExRx) for healthy pregnant women framed by the Frequency, Intensity, Time, and Type (FITT) principle. Methods: In April 2021, PubMed, Scopus, SPORTDiscus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane databases were searched. Reports were eligible if: (1) targeted healthy pregnant women, (2) framed the ExRx by the FITT, and (3) published by a professional society from 2000 to 2021 in English. The Appraisal of Guidelines for Research and Evaluation II tool assessed risk of bias. Results: Twelve reports of poor to good quality were included. Nine societies conducted systematic reviews, but only three provided a detailed, transparent description of the review conducted. Although the FITT varied, the most common was most days of the week, moderate intensity, 30 minutes/session to accumulate 150 minutes/week, and aerobic, resistance, and flexibility exercise with three societies advising neuromotor exercise. All professional societies specified activities to avoid and eight societies included contraindications to exercise. Conclusions: This systematic review produced a consensus ExRx for healthy pregnant women to better inform clinicians about advising their patients to exercise during pregnancy. Future research is needed to determine the upper limits of exercise while pregnant and provide better informed guidance relating to safety concerns for women who are pregnant.
... Specifically, these guidelines recommend an accumulation of at least 150-300 min of moderate-vigorous intensity exercise and two sessions of resistance-based exercise per week for healthy pregnant women, free of medical or obstetric complications to exercise during pregnancy. 3,[9][10][11] Thus, pregnancy is identified as a critical period with increased health risks for both the mother and her child, due to higher than usual levels of inactivity, sedentary behaviours, excessive weight gain and weight retention postpartum. 12 Healthcare practitioners are uniquely placed to provide pregnant women with appropriate and frequent exercise advice. ...
... Two of the 142 women (9%) who participated in this study received the correct guidelines-based advice regarding exercise frequency that 'women should participate in exercise on most, if not all days of the week'. 3,[9][10][11] More women (13%) within this study report being advised by their healthcare practitioner to participate in physical activity "as many times as they liked". This advice is somewhat vague and unclear and does not necessarily encourage women to be active. ...
... 23 In addition, the current evidence-based exercise during pregnancy guidelines recommend that exercise intensity be determined using a 'Talk Test'. 3,[9][10][11] Specifically, a score of 12-14 on the Borg rate of Perceived Exertion Scale (RPE 6-20) is perceived as 'somewhat hard', where you 'can talk but not sing'. 24 However, no participants in the present study reported being advised to use the Talk Test' to help determine and monitor their exercise intensity. ...
Article
Background: Exercise during pregnancy is associated with a variety of health benefits for both mother and child. Despite these benefits, few Australian pregnant women are sufficiently active to meet current exercise during pregnancy guidelines. Healthcare practitioners can play an instrumental role in encouraging women to be active during their pregnancy through the provision of clear and accurate exercise advice. However, little is known about the exercise advice that pregnant women receive from Healthcare practitioners. Methods: Regionally-based Australian women were asked to self-report the exercise advice they received from their Healthcare practitioners during their pregnancy via a survey during one of their clinic visits. Results: Of the 131 participants, 53% (n=70) reported receiving some form of exercise advice from their Healthcare practitioner. Specifically, frequency of exercise was discussed among 34% of the participants (n=23) while exercise intensity 57% was discussed among 57% of the participants (n=38). Exercise duration was discussed among 39% of participants (n=26) and types of exercise was discussed among 84% of the participants (n=56). In most instances, participants report receiving advice not in accordance with current exercise during pregnancy guidelines. Conclusions: Healthcare practitioners may not be actively providing advice to pregnant women about their exercise behaviours. Of the advice that is provided, it may not in accordance with current evidence-based exercise during pregnancy guidelines. Whilst healthcare practitioners may be uniquely positioned to provide exercise advice to pregnant women, they may not have the necessary knowledge, training or support to provide specific exercise advice.
... During pregnancy, women are more likely to make poorer nutritional choices, participate in less physical activity and experience reduced sleep. [1][2][3] As a result, pregnancy is identified as a critical risk period where the risk of adverse health outcomes are heightened. [1][2][3] Research indicates that less than 50% of Australian women consume an adequate diet during pregnancy in accordance with nutritional guidelines, 1 less than 35% are sufficiently active in accordance with exercise during pregnancy guidelines, 2 and between 75% to 83% of women experience poor sleep during pregnancy. ...
... [1][2][3] As a result, pregnancy is identified as a critical risk period where the risk of adverse health outcomes are heightened. [1][2][3] Research indicates that less than 50% of Australian women consume an adequate diet during pregnancy in accordance with nutritional guidelines, 1 less than 35% are sufficiently active in accordance with exercise during pregnancy guidelines, 2 and between 75% to 83% of women experience poor sleep during pregnancy. 3 As a result, pregnant women can suffer from both short-and long term adverse health outcomes. ...
... [1][2][3] As a result, pregnancy is identified as a critical risk period where the risk of adverse health outcomes are heightened. [1][2][3] Research indicates that less than 50% of Australian women consume an adequate diet during pregnancy in accordance with nutritional guidelines, 1 less than 35% are sufficiently active in accordance with exercise during pregnancy guidelines, 2 and between 75% to 83% of women experience poor sleep during pregnancy. 3 As a result, pregnant women can suffer from both short-and long term adverse health outcomes. ...
Article
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Problem: Most pregnant women report using the internet to source health information during pregnancy. However, little is known about the information presented on the internet and whether it is consistent with current evidence-based guidelines. Background: Pregnancy is considered a risk period for women as it is associated with poorer health behaviours including an inadequate diet, decreased physical activity and reduced sleep. As a result, pregnant women and their unborn child are at a greater risk of adverse health outcomes. Aim: The purpose of this study was to review pregnancy related information about nutrition, physical activity and sleep provided on Australian government and leading industry body websites, and to compare this information to current evidence-based guidelines. Methods: A systematic online search was conducted to identify Australian Government, and leading industry websites that provided information on nutrition, physical activity, or sleep during pregnancy. The content of each website was reviewed and compared against current nutrition, physical activity and sleep guidelines. Findings: 27 government and leading industry websites were included in this study. 18 websites included nutritional information, none of which aligned 100% with guidelines. Nine websites included physical activity information, only one of which was 100% in accordance with guidelines. Two websites included information on sleep during pregnancy, however neither were in accordance with guidelines. Conclusion: Women are accessing information via the internet that is not in accordance with current evidence-based guidelines. These results call to attention the need for government and leading industry websites to review and update their website information in accordance with current evidence-based guidelines.
... Better pregnancy outcomes in the setting of GDM may be expected when exercise has been started before pregnancy as compared with exercise started during pregnancy [30]. Nevertheless, with the exception of very few contraindications, it is safe to start exercise for the first time during pregnancy [44,45]. In women with GDM with coexisting obesity, high-intensity exercise can reduce the chances of excessive weight gain [44,45]. ...
... Nevertheless, with the exception of very few contraindications, it is safe to start exercise for the first time during pregnancy [44,45]. In women with GDM with coexisting obesity, high-intensity exercise can reduce the chances of excessive weight gain [44,45]. In addition, the position statement of the American Diabetes Association is that GDM should first be managed with diet and exercise, with medication being administered afterwards if needed [2,3]. ...
... Frequency and duration Regarding the frequency and duration of exercise, both the Society of Obstetricians and Gynecologists of Canada (SOGC) and the CSEP suggest that pregnant women with GDM should follow the same guidelines as other pregnant women [20]. Exercise at a frequency of three to four times a week, with a 50% intensity of VO 2max , totaling 45 min with 5min breaks every 15 min is considered safe and effective [45]. ...
Article
Objective Τo summarize and present the main guidelines for exercise during normal pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM). Methods Relevant guidelines were retrieved through the electronic databases PubMed (MEDLINE), CENTRAL (Cochrane), and Embase; reference sections of the retrieved publications; proceedings of the main congresses in the field; and websites of relevant organizations published during the years 2000–2018. Results All guidelines recommend aerobic training from 60 to 150 min/week, with an upper limit of 30 min/day. Exercise is safe, even on a daily basis. Resistance exercise is suggested by five national guidelines (Australia, Canada, Denmark, Norway, and the UK). Discrepancies exist regarding the recommended intensity of exercise. Canada, Japan, Spain, and the UK use both objective (heart rate and maximum oxygen consumption) and subjective criteria (Borg’s Scale and talk test) to determine the effectiveness and safety of exercise. Only Canada provides specific recommendations, according to the woman’s age and level of physical condition. Women with GDM on no insulin treatment do not need to take extra precautions during exercise. However, due to their condition of hyperglycemia, they must comply with the recommendation issued for type 2 diabetes. The prescription and supervision of exercise should be carried out in a similar way as for uncomplicated pregnancies. Finally, women with GDM on insulin treatment need to follow the same recommendations as for those for pregnant women with type 1 diabetes. Conclusion Health professionals must be informed about the correct planning and execution of physical exercise programs so as to safely achieve the maximum effectiveness of exercise-induced health-related benefits in pregnant women.
... 1 This priority arises from the wellestablished link between physical activity during pregnancy and health benefits for both mother and her unborn child. 2 Despite these benefits, research suggests that <35% of Australian pregnant women are currently meeting exercise during pregnancy guidelines 3 which recommend an accumulation of at least 150 min of moderate-vigorous PA per week, consisting of both aerobic and resistance-based activity. 2 The priority to increase PA among pregnant women is further amplified in rural, regional and remote Australia where pregnant women report lower levels of PA, poorer maternal outcomes and reduced access to specialist health care services. ...
... 1 This priority arises from the wellestablished link between physical activity during pregnancy and health benefits for both mother and her unborn child. 2 Despite these benefits, research suggests that <35% of Australian pregnant women are currently meeting exercise during pregnancy guidelines 3 which recommend an accumulation of at least 150 min of moderate-vigorous PA per week, consisting of both aerobic and resistance-based activity. 2 The priority to increase PA among pregnant women is further amplified in rural, regional and remote Australia where pregnant women report lower levels of PA, poorer maternal outcomes and reduced access to specialist health care services. 4 As a result, medical practitioners in these communities are often required to provide a wider range of antenatal care services, including the provision of PA advice and counselling. ...
... Participants were asked to provide their level of agreement (agree, I don't know, disagree) in response to seven statements that mirror current recommendations provided within Australian evidence-based PA during pregnancy guidelines. 2 Of the 50 medical practitioners who responded (response rate 55-62%), most were women (58%), aged 45+ years (44%), practicing 10+ years (46%), completed their medical training in Australia (78%) and received no formal training on PA in pregnancy (96%). ...
... This module was developed based on the most recent best practice guidelines (Hayman et al., 2016; Department of Health Australia, 2014) on physical activity and exercise during pregnancy. It provides information on the benefits of exercise and physical activity, how much (time and intensity) exercise and physical activity is needed, and, types of physical activity and exercise that are appropriate during pregnancy. ...
Article
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Purpose The purpose of this project was to develop and evaluate an eHealth intervention to promote healthy lifestyle for pregnant women. The setting was a low socio-economic and multi-ethnic area in Melbourne, Australia. Methods This paper briefly describes the development of the eHealth intervention, which was aimed at a low level of literacy, and the evaluation of the intervention by pregnant women. A basic descriptive survey was undertaken to evaluate user friendliness, usefulness and acceptability of the intervention. Results The intervention was developed by a team of experts and forty pregnant women participated in the evaluation. Results indicated that participants found the intervention informative, useful and easy to navigate. They also identified some minor areas for improvement which will be addressed prior to proceeding to a formal controlled evaluation. Conclusion Results from this evaluation are encouraging and suggest that women found the intervention convenient, trustworthy and engaging. Most enjoyed navigating the website information. As such, it is likely to prove a useful support for delivering dietary and exercise information to pregnant women in the local low socio-economic area. Further formal evaluation will test the efficacy of the website in improving diet and exercise outcomes during pregnancy.
... It also decreases the risk of preeclampsia, gestational diabesity and postpartum overweight. Strengthening of pelvic floor muscles reduces back pain [61], reduces urinary incontinence and results in fewer delivery complications and [62,63]. PA also reduces fatigue, stress, anxiety and depression. ...
Article
Healthy lifestyle habits spanning from preconception to postpartum are considered as a major safeguard for achieving successful pregnancies and for prevention of gestational diseases. Among preconception priorities established by the World Health Organization (WHO) are healthy diet and nutrition, weight management, physical activity, planned pregnancy and physical, mental and psychosocial health. Most studies covering the topic of healthy pregnancies focus on maternal diet because obesity increases the risks for adverse perinatal outcomes, including gestational diabetes mellitus, large for gestational age new-borns, or preeclampsia. Thus, foods rich in vegetables, essential and polyunsaturated fats and fibre-rich carbohydrates should be promoted especially in overweight, obese or diabetic women. An adequate intake of micronutrients (e.g. iron, calcium, folate, vitamin D and carotenoids) is also crucial to support pregnancy and breastfeeding. Moderate physical activity throughout pregnancy improves muscle tone and function, besides decreasing the risk of preeclampsia, gestational diabesity (i.e. diabetes associated with obesity) and postpartum overweight. Intervention studies claim that an average of 30 min of exercise/day contribute to longterm benefits for maternal overall health and well-being. Other factors such as microbiome modulation, behavioural strategies (e.g. smoking cessation, anxiety/stress reduction and sleep quality), maternal genetics and age, social class and education might also influence maternal quality of life. These factors contribute to ensure a healthy pregnancy, or at least to reduce the risk of adverse maternal and foetal outcomes during pregnancy and later in life.
... These include greater control of gestational weight gain, decreased risk of pregnancy-related complications, such as preeclampsia and hypertension [1]. Despite these benefits, less than 35% of Australian pregnant women appear sufficiently active [2,3] in accordance with exercise during pregnancy guidelines [4]. ...
Article
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Background: Physical activity (PA) during pregnancy is associated with a variety of health benefits including a reduced risk of pregnancy related conditions such as pre-eclampsia and pregnancy-induced hypertension and leads to greater control over gestational weight gain. Despite these associated health benefits, very few pregnant women are sufficiently active. In an attempt to increase health outcomes, it is important to explore innovative ways to increase PA among pregnant women. Therefore, the aim of this study was to assess the feasibility, acceptability and efficacy of a four week web-based computer-tailored PA intervention among pregnant women. Methods: Seventy-seven participants were randomised into either: (1) an intervention group that received tailored PA advice and access to a resource library of articles relating to PA during pregnancy; or (2) a standard information group that only received access to the resources library. Objective moderate-to-vigorous physical activity (MVPA) was assessed at baseline and immediately post-intervention. Recruitment, attrition, intervention adherence, and website engagement were assessed. Questions on usability and satisfaction were administered post-intervention. Results: Feasibility was demonstrated through acceptable recruitment (8.5 participants recruited and randomised/month), and attrition (25%). Acceptability among intervention group participants was positive with high intervention adherence (96% of 4 modules completed). High website engagement (participants logged in 1.6 times/week although only required to log in once per week), usability (75/100), and satisfaction outcomes were reported in both groups. However, participants in the intervention group viewed significantly more pages on the website (p < 0.05), reported that the website felt more personally relevant (p < 0.05), and significantly increased their MVPA from baseline to post-intervention (mean difference = 35.87 min), compared to the control group (mean difference = 9.83 min) (p < 0.05), suggesting efficacy. Conclusions: The delivery of a computer-tailored web-based intervention designed to increase PA in pregnant women is feasible, well accepted and associated with increases in short-term MVPA. Findings suggest the use of computer-tailored information leads to greater website engagement, satisfaction and greater PA levels among pregnant women compared to a generic information only website. Trial registration: The trial was 'retrospectively registered' with the Australian New Zealand Clinical Trials Registry ( ACTRN12614001105639 ) on 17(th) October, 2014.
Article
Objectives To develop Australian guidelines on physical activity/exercise during pregnancy and the postpartum period. Design Critical 'umbrella' reviews of the scientific evidence, combined with adaptation of recently published guidelines. Method A five stage approach included: identification of key source documents (including national PA/exercise guidelines and position statements from professional organisations, published since 2010); narrative review of evidence relating to 27 health outcomes; summarising the evidence; development of draft guidelines and supporting information; and review and consultation to finalise the guidelines. Results Our evidence review found that PA/exercise during pregnancy and the postpartum period is safe, has health benefits for the woman and her unborn child, and may reduce the risks of some pregnancy related complications. Four specific guidelines were developed. These encourage all women without pregnancy complications to: (1) meet the Australian Physical Activity and Sedentary Behaviour Guidelines for Adults before, during and after pregnancy; (2) modify activities to accommodate the physical changes that occur as pregnancy progresses; (3) do pelvic floor exercises during and after pregnancy; (4) take an active role in shared decision-making about their physical activity/exercise during and after pregnancy. The review also identified warning signs and contraindications for PA/exercise during pregnancy. Conclusions All women who are pregnant or planning a pregnancy should be aware of the benefits of PA/exercise, and health professionals should encourage safe levels of activity and be familiar with the contraindications, signs and symptoms which suggest that PA/exercise should be modified or avoided.
Article
Background Postnatal women are commonly physically inactive, and, when coupled with depressive symptoms, barriers to physical activity can be heightened. This study aimed to 1) examine the feasibility and acceptability of a multi-component home-based physical activity intervention delivered to mothers at risk of postnatal depression, and 2) examine changes in health behaviours (physical activity, sedentary behaviour, sleep, diet) and indicators of mental health. Methods Sixty-two mothers (3 – 9 months postpartum) who at baseline were insufficiently active and experiencing heightened depressive symptoms were recruited into a 12-week randomised controlled trial in 2018. Participants were randomised into either a) Intervention group (receiving a theoretically underpinned multi-component program including free exercise equipment at home, access to smartphone web-app, and an online forum); or b) Control group (usual routine). Primary outcomes were program feasibility and acceptability. Secondary outcomes included self-reported and accelerometer-assessed physical activity and sedentary behavior, sleep, diet, determinants of physical activity, and mental health (depressive and anxiety symptoms), measured at baseline and follow-up (12-weeks), with self-reported physical activity, sedentary behaviour and depressive symptoms also measured at weeks 4 and 8. Qualitative data was analysed following inductive content analysis, and quantitative data using linear mixed models. Results Exercise equipment use in the home was shown to be a feasible strategy to re-engage postnatal women in physical activity. Other components of the program (e.g. web-app, online forum) had low compliance. The program had high acceptability, predominately due to its accessibility, flexibility and ability to overcome key barriers to physical activity. The program resulted in improvements in short-term self-reported physical activity (increased 162min/week at 4 weeks, 95% CI: 37.7, 286.2), behavioural skills (B=0.4, 95% CI: 0.0, 0.8) and perceived barriers to physical activity. However, accelerometer measured physical activity decreased in the intervention group, compared to control group at week 12 (B=-1.3, 95% CI:-2.5, -0.1). There were no changes in other outcomes. Conclusions A home-based physical activity program involving free exercise equipment is acceptable and feasible amongst women experiencing heightened postnatal depressive symptoms. Such programs may be effective in increasing engagement in physical activity, yet additional strategies may be needed to enhance maintenance of physical activity and improvements in mental health.
Research
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Pregnancy and Exercise Fact Sheet developed as a part of SMA's Women in Sport Fact Sheet Series
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Although there is no consensus as to whether exercise is beneficial during pregnancy, most studies report it poses no risk to either the mother or the fetus, and many suggest it to be beneficial to both. This review, which examines the evidence available, also reveals the many differences in study design followed, the type of exercise undertaken and the variables measured, which make it difficult to compare results. Advances in our understanding of the effects of exercise during pregnancy might best be made by undertaking randomised clinical trials with standardised protocols. However, most of the studies examining the relationship between exercise and pregnancy report no complications on maternal or fetal well-being. This is also in line with recent review studies advising that the pregnant population without obstetric contraindications should be encouraged to exercise during pregnancy. Therefore, the results of the present review stimulate those responsible for the healthcare of the pregnant woman to recommend moderate exercise throughout pregnancy without risk to maternal and fetal health. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Article
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A physical inactive lifestyle is associated with increased prevalence of chronic diseases such as cardiovascular disease, type 2 diabetes, osteoporosis and cancer. The proportion of pregnant women with overweight or obesity is increasing rapidly across the world and this excess weight, mainly obesity, is associated with increased risk of health problems during pregnancy and in connection with childbirth. Pregnancy poses significant physiological changes in the body and thus many pregnant women are worried about being physically active or exercising during this period. This literature review aimed to determine the advantages or disadvantages, current recommendations and restrictions on physical activity and exercise during normal pregnancy. Searches were carried out on databases PubMed, CINHAL and the Cochrane Library. The review indicates that all healthy pregnant women can be physically active to achieve health benefits. Physical activity and exercise during pregnancy does not increase any risk of adverse pregnancy or birth outcomes, not even for elite athlete women. All healthy pregnant women can remain physically active. However, high-risk sports or hard working should be avoided; greater caution and carefulness should be taken to avoid any unexpected complications and elite knowledge about physical activity and exercise during normal pregnancy is necessary.
Article
In 2002, the American College of Obstetricians and Gynecologists published exercise guidelines for pregnancy, which suggested that in the absence of medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women. However, these guidelines did not define 'moderate intensity' or the specific amount of weekly caloric expenditure from physical activity required. Recent research has determined that increasing physical activity energy expenditure to a minimum of 16 metabolic equivalent task (MET) hours per week, or preferably 28 MET hours per week, and increasing exercise intensity to >= 60% of heart rate reserve during pregnancy, reduces the risk of gestational diabetes mellitus and perhaps hypertensive disorders of pregnancy (i.e. gestational hypertension and pre-eclampsia) compared with less vigorous exercise. To achieve the target expenditure of 28 MET hours per week, one could walk at 3.2 km per hour for 11.2 hours per week (2.5 METs, light intensity), or preferably exercise on a stationary bicycle for 4.7 hours per week (similar to 6-7 METs, vigorous intensity). The more vigorous the exercise, the less total time of exercise is required per week, resulting in >= 60% reduction in total exercise time compared with light intensity exercise. Light muscle strengthening performed over the second and third trimester of pregnancy has minimal effects on a newborn infant's body size and overall health. On the basis of this and other information, updated recommendations for exercise in pregnancy are suggested.
Article
Life events unique to the perinatal period may place a woman at greater risk for decreased physical activity and increased postpartum weight retention (PPWR). Study purposes were to determine a) the relationship between women's postpartum self-efficacy (SE) to overcome perceived barriers to exercise with current and past pregnancy leisure-time physical activity (LTPA), and b) the relationship between LTPA and PPWR. A Modifiable Activity Questionnaire was used to assess current and past pregnancy LTPA (Met*h/wk) at 20 and 32 weeks gestation and 12 weeks postpartum. Current barriers to LTPA and SE were assessed via the Perceived Barriers Efficacy Questionnaire. Top three barrier values were averaged to obtain an overall SE score for participants (N=30). Pearson correlations were run between LTPA, PPWR and SE scores. ANOVA was used to compare PPWR between women who did and did not meet LTPA guidelines of 7.5 MET*h/wk. The top three barriers to LTPA were time, motivation, and childcare. Positive correlations (p≤0.01) were found between SE levels and LTPA at all time periods of interest. LTPA was inversely related to PPWR. Relationships between SE, LTPA, and PPWR helped validate the need to promote perinatal PA, to aid long term weight management.
Article
Gestational diabetes mellitus (GDM) is a common complication of pregnancy associated with an increased incidence of pregnancy complications, adverse pregnancy outcomes, and maternal and fetal risks of chronic health conditions later in life. Physical activity has been proposed to reduce the risk of GDM and is supported by observational studies, but experimental research assessing its effectiveness is limited and conflicting. We aimed to use meta-analysis to synthesize existing randomized controlled studies of physical activity and GDM. We searched MEDLINE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for eligible studies. The following combination of keywords was used: (pregnant or pregnancy or gestation or gestate or gestational or maternity or maternal or prenatal) AND (exercise or locomotion or activity or training or sports) AND (diabetes or insulin sensitivity or glucose tolerance) AND (random* or trial). Eligibility was restricted to studies that randomized participants to an exercise-only-based intervention (ie, separate from dietary interventions) and presented data regarding GDM risk. Two authors performed the database search, assessment of eligibility, and abstraction of data from included studies, and a third resolved any discrepancies. A total of 469 studies was retrieved, of which 10 met inclusion criteria and could be used for analysis (3,401 participants). Fixed-effects models were used to estimate summary relative risk (RR) and 95% confidence interval (CI) and I to assess heterogeneity. There was a 28% reduced risk (95% CI 9-42%) in the intervention group compared with the control group (RR 0.72, P=.005). Heterogeneity was low (I=12%) and nonsignificant (P=.33). The results from this meta-analysis suggest that physical activity in pregnancy provides a slight protective effect against the development of GDM. Studies evaluating type, timing, duration, and compliance of physical activity regimens are warranted to best inform obstetric guidelines.
Article
Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety. This review summarizes current guidelines for postpartum physical activity worldwide. PubMed (MEDLINE) was searched for country-specific government and clinical guidelines on physical activity after pregnancy through the year 2013. Only the most recent guideline was included in the review. An abstraction form facilitated extraction of key details and helped to summarize results. Six guidelines were identified from 5 countries (Australia, Canada, Norway, United Kingdom, and United States). All guidelines were embedded within pregnancy-related physical activity recommendations. All provided physical activity advice related to breastfeeding and 3 remarked about physical activity after cesarean delivery. Recommended physical activities mentioned in the guidelines included aerobic (3/6), pelvic floor exercise (3/6), strengthening (2/6), stretching (2/6), and walking (2/6). None of the guidelines discussed sedentary behavior. The guidelines that were identified lacked specificity for physical activity. Greater clarity in guidelines would be more useful to both practitioners and the women they serve. Postpartum physical activity guidelines have the potential to assist women to initiate or resume physical activity after childbirth so that they can transition to meeting recommended levels of physical activity. Health care providers have a critical role in encouraging women to be active at this time, and the availability of more explicit guidelines may assist them to routinely include physical activity advice in their postpartum care.
Article
Background Antenatal depression can have harmful consequences for the mother and fetus. Exercise may be a useful intervention to prevent and treat antenatal depression.Objectives This systematic review aims to establish whether there is sufficient evidence to conclude that exercise is an effective intervention for preventing and treating antenatal depression.Search strategySearches using electronic databases from MEDLINE, Cochrane Library, CINAHL, EMBASE, AMED and PsycINFO were performed.Selection criteriaRandomised controlled trials (RCT) that compared any type of exercise intervention with any comparator in pregnant women were eligible for inclusion.Data collection and analysisMeta-analysis was performed calculating standardised mean differences (SMD).Main resultsSix trials (seven comparisons) were eligible for inclusion. Meta-analysis showed a significant reduction in depression scores (SMD −0.46, 95% CI −0.87 to −0.05, P = 0.03, I2 = 68%) for exercise interventions relative to comparator groups. The test for subgroup differences in women who were non-depressed (one trial) (SMD −0.74, 95%CI −1.22 to −0.27, P = 0.002) and depressed (five trials) (SMD −0.41, 95% CI −0.88 to 0.07, P = 0.09) at baseline was not significant (P = 0.32). The test for subgroup differences between aerobic (one trial) and non-aerobic exercise (five trials) was also nonsignificant (P = 0.32).Authors' conclusionsWe found some evidence that exercise may be effective in treating depression during pregnancy but this conclusion is based on a small number of low-moderate quality trials with significant heterogeneity and wide confidence intervals.
Article
Objective: The purpose of this study was to evaluate the effect of structured physical exercise programs during pregnancy on the course of labor and delivery. Study design: We conducted a systematic review and metaanalysis using the following data sources: Medline and The Cochrane Library. In our study, we used randomized controlled trials (RCT) that evaluated the effects of exercise programs during pregnancy on labor and delivery. The results are summarized as relative risks. Results: In the 16 RCTs that were included there were 3359 women. Women in exercise groups had a significantly lower risk of cesarean delivery (relative risk, 0.85; 95% confidence interval [CI], 0.73-0.99). Birthweight was not significantly reduced in exercise groups. The risk of instrumental delivery was similar among groups (relative risk, 1.00; 95% CI, 0.82-1.22). Data on Apgar score, episiotomy, epidural anesthesia, perineal tear, length of labor, and induction of labor were insufficient to draw conclusions. With the use of data from 11 studies (1668 women), our analysis showed that women in the exercise groups gained significantly less weight than women in control groups (mean difference, -1.13 kg; 95% CI, -1.49 to -0.78). Conclusion: Structured physical exercise during pregnancy reduces the risk of cesarean delivery. This is an important finding to convince women to be active during their pregnancy and should lead the physician to recommend physical exercise to pregnant women, when this is not contraindicated.