Exercising During Pregnancy – A review of the 2019 Canadian guidelines for physical activity throughout pregnancy

For a lot of women, knowing how to safely exercise during pregnancy can be very confusing.  There is a lot of information out there and sifting through what is up to date and accurate versus what is out of date and inaccurate information can be difficult. Although this is an area in need of more research, the good news is that the research is expanding and more evidence based information is being provided to women to enable them to make well informed decisions that will benefit both them and their baby when it comes to exercise during pregnancy. 

In 2019, the British Journal of Sports Medicine published a consensus statement titled ‘2019 Canadian Guidelines for Physical Activity throughout pregnancy’.  One of the key recommendations was that women should be aiming to get at least 150 minutes of moderate intensity activity per week throughout their pregnancy.  This can lead to significant health benefits for both mother and baby without any associated risks of complications such as miscarriage, small baby or preterm birth.

The research team behind these guidelines included researchers from the University of Alberta working in collaboration with Midwives, Obstetricians & Gynecologists, Family Physicians & Exercise Physiologists. A full review of the available literature at the time of publication of this paper was carried out to provide the most up to date and evidence informed guidelines for women wanting to exercise during pregnancy.  This is a free access article, to read the full article, follow this link.  

Recommendations provided by these guidelines is intended for pregnant women without contraindications to physical activity during pregnancy.  For a full detailed list of the absolute and relative contraindications to exercise during pregnancy, please follow this link to the full article.  It is also recommended that you discus any medical concerns around exercising during pregnancy with your health care provider. 

One of the main important findings from the research is that physical exercise throughout pregnancy has no association with miscarriage, stillbirth, neonatal death, preterm birth, preterm/prelabour rupture of membranes, neonatal hypoglycaemia, low birth weight, birth defects, induction of labour or birth complications.  In fact the finding show that regular physical activity is associated with a 40% reduction in the risk of gestational diabetes, pre-eclampsia and gestational hypertension and a 67% reduction in prenatal depression. By not engaging in regular physical activity throughout pregnancy, risks of these complications and others such as excessive gestational weight gain, caesarean section, instrumental delivery, urinary incontinence, lumbopelvic pain and severity of depressive symptoms all increased.  The recommendation for 150 minutes of moderate intensity exercise per week is also targeted towards women who were previously inactive prior to pregnancy and women who are overweight or obese.

With the recommendation of accumulating 150 minutes of moderate intensity exercise per week, the authors suggest that women aim to achieve this target over three or more days per week.  The authors also note that accumulating more physical activity (frequency, duration or volume) over the week was associated with greater benefits; however physical activity below the recommendations also incurred some benefits and therefore should still be recognised as beneficial even if women are not able to meet the 150 minute target.  The study also found that a combination of aerobic exercise and resistance training was more effective at improving health outcomes than a program that focused on aerobic exercise alone. 

Guidelines to measure moderate intensity level activity was by maternal heart rate.   Pregnancy-specific target heart rate zones for women who wish to monitor their heart rate during physical activity was provided in the study and can be viewed here. Other measures of physical activity intensity include the ‘talk test’. As the term ‘talk test’ implies, the woman is at a comfortable intensity if she is able to maintain a conversation during physical activity and should reduce the intensity if this is not possible.  These recommendations of physical activity intensity are based around the available research evidence at the time of publication.  The authors note that the highest intensity of exercise studied in the available literature was equivalent to jogging.  Therefore, they were unable to make recommendations based on the available evidence for physical activity intensity higher than this. 

Here is a summary of the key recommendations for physical activity during pregnancy outlined in the guidelines 

1. All women without contraindication should be physically active throughout pregnancy
2. Pregnant women should accumulate at least 150 min of moderate-intensity physical activity each week to achieve clinically meaningful reductions in pregnancy complications
3. Physical activity should be accumulated over a minimum of 3 days per week; however, being active every day is encouraged.
4. Pregnant women should incorporate a variety of aerobic exercise and resistance training activities to achieve greater benefits. Adding yoga and/or gentle stretching may also be beneficial.
5. Pelvic floor muscle training (eg, Kegel exercises) may be performed on a daily basis to reduce the odds of urinary incontinence. Instruction on the proper technique is recommended to obtain optimal benefits.
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

The authors also recognise that meeting these guidelines may be challenging for a lot of women for a variety of reasons.  They therefore recommend that any women needing further guidance discuss with and seek assistance from their health care team including their obstetrician, midwife, general practitioner and physiotherapist, especially those specialising in pelvic floor physiotherapy. 

At Trillium Integrative Health Centre, we have two pelvic floor physiotherapists, Hannah and Simone, who would be happy to help and guide you though exercising safely throughout your pregnancy.  To schedule an appointment, click on the link or call the clinic at 778-640-1119.