Physical Activity and Pregnancy

Cardiovascular Adaptations, Recommendations and Pregnancy Outcomes

Abstract

Regular physical activity is associated with improved physiological, metabolic and psychological parameters, and with reduced risk of morbidity and mortality. Current recommendations aimed at improving the health and wellbeing of nonpregnant subjects advise that an accumulation of ≥30 minutes of moderate physical activity should occur on most, if not all, days of the week.

Regardless of the specific physiological changes induced by pregnancy, which are primarily developed to meet the increased metabolic demands of mother and fetus, pregnant women benefit from regular physical activity the same way as nonpregnant subjects.

Changes in submaximal oxygen uptake (V̇O2) during pregnancy depend on the type of exercise performed. During maternal rest or submaximal weight-bearing exercise (e.g. walking, stepping, treadmill exercise), absolute maternal V̇O2 is significantly increased compared with the nonpregnant state. The magnitude of change is approximately proportional to maternal weight gain.

When pregnant women perform submaximal weight-supported exercise on land (e.g. level cycling), the findings are contradictory. Some studies reported significantly increased absolute V̇O2, while many others reported unchanged or only slightly increased absolute V̇O2 compared with the nonpregnant state. The latter findings may be explained by the fact that the metabolic demand of cycle exercise is largely independent of the maternal body mass, resulting in no absolute V̇O2 alteration.

Few studies that directly measured changes in maternal maximal V̇O2 (V̇O2max) showed no difference in the absolute V̇O2max between pregnant and nonpregnant subjects in cycling, swimming or weight-bearing exercise. Efficiency of work during exercise appears to be unchanged during pregnancy in non-weight-bearing exercise. During weight-bearing exercise, the work efficiency was shown to be improved in athletic women who continue exercising and those who stop exercising during pregnancy. When adjusted for weight gain, the increased efficiency is maintained throughout the pregnancy, with the improvement being greater in exercising women.

Regular physical activity has been proven to result in marked benefits for mother and fetus. Maternal benefits include improved cardiovascular function, limited pregnancy weight gain, decreased musculoskeletal discomfort, reduced incidence of muscle cramps and lower limb oedema, mood stability, attenuation of gestational diabetes mellitus and gestational hypertension. Fetal benefits include decreased fat mass, improved stress tolerance, and advanced neurobehavioural maturation. In addition, few studies that have directly examined the effects of physical activity on labour and delivery indicate that, for women with normal pregnancies, physical activity is accompanied with shorter labour and decreased incidence of operative delivery.

However, a substantial proportion of women stop exercising after they discover they are pregnant, and only few begin participating in exercise activities during pregnancy. The adoption or continuation of a sedentary lifestyle during pregnancy may contribute to the development of certain disorders such as hypertension, maternal and childhood obesity, gestational diabetes, dyspnoea, and pre-eclampsia. In view of the global epidemic of sedentary behaviour and obesity-related pathology, prenatal physical activity was shown to be useful for the prevention and treatment of these conditions. Further studies with larger sample sizes are required to confirm the association between physical activity and outcomes of labour and delivery.

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Acknowledgements

The study was supported in part by a competitive grant attributed to Drs Boulvain and Kayser by the Clinical Research Centre, Faculty of Medicine, University of Geneva, and was further supported by the Faculty of Medicine of the University of Geneva, and the University Hospitals of Geneva, Switzerland. The SOGC guideline has been provided free of charge courtesy of the Society of Obstetricians and Gynecologists of Canada. The authors have no conflicts of interest that are directly relevant to the content of this review.

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Correspondence to Professor Bengt Kayser.

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Melzer, K., Schutz, Y., Boulvain, M. et al. Physical Activity and Pregnancy. Sports Med 40, 493–507 (2010). https://doi.org/10.2165/11532290-000000000-00000

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Keywords

  • Physical Activity
  • Fetal Heart Rate
  • Moderate Physical Activity
  • Physical Activity Recommendation
  • Maternal Weight Gain