Evidence-Based and Practice-Oriented Guidelines for Exercising During Pregnancy

  • Anna SzumilewiczEmail author
  • Aneta Worska
  • Rita Santos-Rocha
  • Miguel Ángel Oviedo-Caro


Physical activity is associated with many health benefits during pregnancy, delivery, and the postpartum period. The last two decades produced an increasing amount of scientific evidence on the positive effects of the prenatal physical activity on the maternal and fetal health, as well as in pregnancy outcomes. However, authors from different countries observe insufficient level of physical activity in pregnant women. The lack of information among women on the exercises during pregnancy and lack of social support are two of the reasons hindering engagement in a prenatal exercise program. According to other studies, the knowledge of health benefits can lead to more favorable attitudes toward exercise during pregnancy, among women, exercise professionals, and healthcare providers. The purpose of this chapter is to review the information provided in the current guidelines for exercise during pregnancy in different countries, regarding the contents related to prenatal exercise programs.


Guidelines Exercise Physical activity Pregnancy Postpartum 


  1. 1.
    Kader M, Naim-Shuchana S. Physical activity and exercise during pregnancy. Eur J Phys. 2014;16(1):2–9.Google Scholar
  2. 2.
    Bø K, Artal R, Barakat R, Brown W, Davies GAL, Dooley M, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1-exercise in women planning pregnancy and those who are pregnant. Br J Sports Med. 2016;50(10):571–89.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Bo K, Artal R, Barakat R, Brown W, Dooley M, Evenson KR, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2-the effect of exercise on the fetus, labour and birth. Br J Sports Med. 2016;50(21):1297–305.PubMedGoogle Scholar
  4. 4.
    Nascimento SL, Surita FG, Cecatti JG. Physical exercise during pregnancy: a systematic review. Curr Opin Obstet Gynecol. 2012;24(6):387–94.PubMedGoogle Scholar
  5. 5.
    Downs DS, Chasan-Taber L, Evenson KF, Leiferman J, Yeo S. Physical activity and pregnancy: past and present evidence and future recommendations. Res Q Exerc Sport. 2012;83(4):485–502.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Hagen Haakstad LA, Voldner N, Bø K. Stages of change model for participation in physical activity during pregnancy. J Pregnancy. 2013;2013:1–7.Google Scholar
  7. 7.
    Ruchat S-M, Mottola MF. Preventing long-term risk of obesity for two generations: prenatal physical activity is part of the puzzle. J Pregnancy. 2012;2012:470247.PubMedPubMedCentralGoogle Scholar
  8. 8.
  9. 9.
    Evenson KR, Savitz DA, Huston SL. Leisure-time physical activity among pregnant women in the US. Paediatr Perinat Epidemiol. 2004;18(6):400–7.PubMedGoogle Scholar
  10. 10.
    Petersen AM, Leet TL, Brwonson RC. Correlates of physical activity among pregnant women in the United States. Med Sci Sports Exerc. 2005;37(10):1748–53.PubMedGoogle Scholar
  11. 11.
    Liu J, Blair SN, Teng Y, Ness AR, Lawlor DA, Riddoch C. Physical activity during pregnancy in a prospective cohort of British women: results from the Avon longitudinal study of parents and children. Eur J Epidemiol. 2011;26(3):237–47.PubMedGoogle Scholar
  12. 12.
    Amezcua-Prieto C, Lardelli-Claret P, Olmedo-Requena R, Mozas-Moreno J, Bueno-Cavanillas A, JimÉNez-MoleÓN JJ. Compliance with leisure-time physical activity recommendations in pregnant women. Acta Obstet Gynecol Scand. 2011;90(3):245–52.PubMedGoogle Scholar
  13. 13.
    Juhl M, Madsen M, Andersen AMN, Andersen PK, Olsen J. Distribution and predictors of exercise habits among pregnant women in the Danish National Birth Cohort. Scand J Med Sci Sports. 2012;22(1):128–38.PubMedGoogle Scholar
  14. 14.
    Wojtyła A, Kapka-Skrzypczak L, Paprzycki P, Skrzypczak M, Biliński P. Epidemiological studies in Poland on effect of physical activity of pregnant women on the health of offspring and future generations – adaptation of the hypothesis development origin of health and diseases. Ann Agric Environ Med. 2012;19(2):315–26.PubMedGoogle Scholar
  15. 15.
    Gaston A, Vamos C. Leisure-time physical activity patterns and correlates among pregnant women in Ontario, Canada. Matern Child Health J. 2013;17(3):477–84.Google Scholar
  16. 16.
    Santos PC, Abreu S, Moreira C, Lopes D, Santos R, Alves O, et al. Impact of compliance with different guidelines on physical activity during pregnancy and perceived barriers to leisure physical activity. J Sports Sci. 2014;32(14):1398–408.PubMedGoogle Scholar
  17. 17.
    Christopher PC, Deborah LF, James MP. Overcoming barriers to physical activity during pregnancy and the postpartum period: the potential impact of social support. Kinesiol Rev. 2014;3(2):135–48.Google Scholar
  18. 18.
    Atkinson L, Parsons J, Jackson BR. Exercise in pregnancy – UK women’s views and experiences: results of an online survey. Pregnancy Hypertens. 2014;4(3):231.PubMedGoogle Scholar
  19. 19.
    Petrov Fieril K, Fagevik Olsén M, Glantz A, Larsson M. Experiences of exercise during pregnancy among women who perform regular resistance training: a qualitative study. Phys Ther. 2014;94(8):1135–43.PubMedGoogle Scholar
  20. 20.
    Thornton PL, Kieffer EC, Salabarria-Pena Y, Odoms-Young A, Willis SK, Kim H, et al. Weight, diet, and physical activity-related beliefs and practices among pregnant and postpartum Latino women: the role of social support. Matern Child Health J. 2006;10(1):95–104.PubMedGoogle Scholar
  21. 21.
    Evenson KR, Bradley CB. Beliefs about exercise and physical activity among pregnant women. Patient Edu Counsel. 2010;79(1):124–9.Google Scholar
  22. 22.
    Cannella D, Lobel M, Monheit A. Knowing is believing: information and attitudes towards physical activity during pregnancy. J Psychosom Obstet Gynecol. 2010;31(4):236–42.Google Scholar
  23. 23.
    Mbada CE, Adebayo OE, Adeyemi AB, Arije OO, Dada OO, Akinwande OA, et al. Knowledge and attitude of Nigerian pregnant women towards antenatal exercise: a cross-sectional survey. ISRN Obstet Gynecol. 2014;2014:1–8.Google Scholar
  24. 24.
    Gouveia R, Martins S, Sandes AR, Nascimento C, Figueira J, Valente S, et al. Pregnancy and physical exercise: myths, evidence and recommendations; Portuguese. Acta Medica Port. 2007;20(3):209–14.Google Scholar
  25. 25.
    Tanha FD, Ghajarzadeh M, Mohseni M, Shariat M, Ranjbar M. Is ACOG guideline helpful for encouraging pregnant women to do exercise during pregnancy? Acta Med Iran. 2014;52(6):458–61.Google Scholar
  26. 26.
    van Poppel M, Owe K, Santos-Rocha R, Dias H. Physical activity, exercise, and health promotion for the pregnant exerciser and the pregnant athlete. In: Santos-Rocha R, editor. Exercise and sporting activity during pregnancy evidence-based guidelines. Cham: Springer; 2018.Google Scholar
  27. 27.
    Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):791–802.PubMedGoogle Scholar
  28. 28.
    ACSM. In: Thompson WR, editor. ACSM’s resources for the personal trainer. 5th ed: Wolters Kluwer Health; 2017. p. 632.Google Scholar
  29. 29.
    Berk B. Motherwell maternity fitness plan. Champaign, IL: Human Kinetics; 2005. p. 2004-09-27, 232.Google Scholar
  30. 30.
    Clapp JF, Cram C. Exercise through your pregnancy. 2nd ed. Omaha, NB: Addicus Books; 2012. p. 268.Google Scholar
  31. 31.
    Evenson KR, Barakat R, Brown WJ, Dargent-Molina P, Haruna M, Mikkelsen EM, et al. Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med. 2014;8(2):102–21.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Szumilewicz A, Worska A, Rajkowska N, Santos-Rocha R. Summary of guidelines for exercise in pregnancy – are they comprehensive enough for designing the contents of a prenatal exercise program? Curr Women’s Health Rev. 2015;11(1):3–12.Google Scholar
  33. 33.
    Hayman M, Brown W, Ferrar K, Marchese R, Tan J. SMA position statement for exercise in pregnancy and the postpartum period. 2016. Available from: Scholar
  34. 34.
  35. 35.
    Davies GAL, Wolfe LA, Mottola MF, MacKinnon C, Arsenault M-Y, Bartellas E, et al. Exercise in pregnancy and the postpartum period. JOGC. 2003;25(6):516–29.PubMedGoogle Scholar
  36. 36.
    Alleyne J. Position statement: exercise and pregnancy. 2008. Available from: Scholar
  37. 37.
    Healthy habits – before, during and after pregnancy. 2010. Available from:
  38. 38.
    Holan S, Mathiesen M, Petersen K. A national clinical guideline for antenatal care. Short version. 2005. Available from:
  39. 39.
    Barsky E, Smith T, Patricios J, Collins R, Branfield A, Ramagole M. South African Sports Medicine Association position statement on exercise in pregnancy. S Afr J Sports Med. 2012;24(2):69–71.Google Scholar
  40. 40.
    RCOG. RCOG statement no. 4. Exercise in pregnancy. London: Royal College of Obstetricians and Gynaecologists (RCOG); 2006. Available from: Google Scholar
  41. 41.
    ACOG. Physical activity and exercise during pregnancy and the postpartum period. Committee opinion no 650. Washington, DC: The American College of Obstetricians and Gynecologists (ACOG); 2015.Google Scholar
  42. 42.
    DHHS US. Physical activity guidelines for Americans. Washington, DC: U.S. Department of Human and Health Services; 2008. Available from: Google Scholar
  43. 43.
    ACNM. Exercise in pregnancy. J Midwifery Women’s Health. 2014;59(4):473–4.Google Scholar
  44. 44.
    ACSM Current comment: exercise during prgnancy [press release].Google Scholar
  45. 45.
    Bo K, Artal R, Barakat R, Brown WJ, Davies GAL, Dooley M, et al. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC Expert Group Meeting, Lausanne. Part 3-exercise in the postpartum period. Br J Sports Med. 2017;51(21):1516–25.PubMedGoogle Scholar
  46. 46.
    SMA. Exercise in pregnancy and the postpartum period: new position statement. Sport Health. 2016;34(2):10–6.Google Scholar
  47. 47.
    Bo K, Artal R, Barakat R, Brown WJ, Davies GAL, Dooley M, et al. Exercise and pregnancy in recreational and elite athletes: 2016/17 evidence summary from the IOC expert group meeting, Lausanne. Part 4-Recommendations for future research. Br J Sports Med. 2017;51(24):1724–6.PubMedGoogle Scholar
  48. 48.
    Beyaz EA, Özcan E, Ketenci A, Beyaz MM. The effectiveness of pregnancy rehabilitation: effects on low back pain and calf cramps during pregnancy and pregnancy outcomes. Gebelik Rehabilitasyonunun Etkinliği: Gebelik Sirasindaki Bel Ağrisi ve Baldir Kramplarina ve Gebelik Sonuçlarina Etkileri. 2011;7(2):67–74.Google Scholar
  49. 49.
    Piper TJ, Jacobs E, Haiduke M, Waller M, McMillan C. Core training exercise selection during pregnancy. Strength Conditioning J. 2012;34(1):55–62.Google Scholar
  50. 50.
    Santos-Rocha R, Szumilewicz A, Perales M, Pajaujiene S. Europe active standards EQF level 5 – pregnancy and postnatal exercise specialist. Bruxelles: EuropeActive; 2016. Available from: Google Scholar
  51. 51.
    ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002;99(1):171–3.Google Scholar
  52. 52.
    SMA. SMA statement the benefits and risks of exercise during pregnancy. J Sci Med Sport. 2002;5(1):11–9.Google Scholar
  53. 53.
    Kehler AK, Heinrich KM. A selective review of prenatal exercise guidelines since the 1950s until present: written for women, health care professionals, and female athletes. Women Birth. 2015;28(4):E93–E8.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Tafari N, Naeye RL, Gobezie A. Effects of maternal undernutrition and heavy physical work during pregnancy on birth-weight. Br J Obstet Gynaecol. 1980;87(3):222–6.PubMedGoogle Scholar
  55. 55.
    Terada M. Effect of physical activity before pregnancy on fetuses of mice exercised forcibly during pregnancy. Teratology. 1974;10(2):141–4.PubMedGoogle Scholar
  56. 56.
    Mottola MF. Components of exercise prescription and pregnancy. Clin Obstet Gynecol. 2016;59(3):552–8.PubMedGoogle Scholar
  57. 57.
    Ruchat SM, Davenport MH, Giroux I, Hillier M, Batada A, Sopper MM, et al. Walking program of low or vigorous intensity during pregnancy confers an aerobic benefit. Int J Sports Med. 2012;33(8):661–6.PubMedGoogle Scholar
  58. 58.
    Artal R. Exercise during pregnancy and the postpartum period. Alphen aan den Rijn: Wolters Kluwer; 2017. Available from: Google Scholar
  59. 59.
    Juhl M, Strandberg-Larsen K, Larsen PS, Andersen PK, Svendsen SW, Bonde JP, et al. Occupational lifting during pregnancy and risk of fetal death in a large national cohort study. Scand J Work Environ Health. 2013;39(4):335–42.PubMedGoogle Scholar
  60. 60.
    Conger J, Magann EF. Diving and pregnancy: what do we really know? Obstet Gynecol Surv. 2014;69(9):551–6.PubMedGoogle Scholar
  61. 61.
    Krans EE, Chang JC. Low-income African American Women’s beliefs regarding exercise during pregnancy. Matern Child Health J. 2012;16(6):1180–7.PubMedGoogle Scholar
  62. 62.
    Karowicz-Bilińska A, Sikora A, Estemberg D, Brzozowska M, Berner-Trabska M, Kuś E, et al. Physiotherapy in obstetrics. Ginekol Pol. 2010;81(6):441–5.PubMedGoogle Scholar
  63. 63.
    Zwelling E. Overcoming the challenges: maternal movement and positioning to facilitate labor progress. Am J Matern Child Nurs. 2010;35(2):72–8.Google Scholar
  64. 64.
    Artieta-Pinedo I, Paz-Pascual C, Grandes G, Espinosa M. Framework for the establishment of a feasible, tailored and effective perinatal education programme. BMC Pregnancy Childbirth. 2017;17:1–10.Google Scholar
  65. 65.
    Miquelutti MA, Cecatti JG, Makuch MY. Antenatal education and the birthing experience of Brazilian women: a qualitative study. BMC Pregnancy Childbirth. 2013;13(1):1–8.Google Scholar
  66. 66.
    Levett KM, Smith CA, Bensoussan A, Dahlen HG. The complementary therapies for labour and birth study making sense of labour and birth – experiences of women, partners and midwives of a complementary medicine antenatal education course. Midwifery. 2016;40:124–31.PubMedGoogle Scholar
  67. 67.
    Shiri R, Coggon D, Falah-Hassani K. Exercise for the prevention of low back and pelvic girdle pain in pregnancy: a meta-analysis of randomized controlled trials. Eur J Pain (London). 2018;22(1):19–27.Google Scholar
  68. 68.
    Magro-Malosso ER, Saccone G, Di Tommaso M, Roman A, Berghella V. Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2017;96(8):921–31.PubMedGoogle Scholar
  69. 69.
    Lemos A, de Souza AI, Ferreira ALCG, Figueiroa JN, Cabral-Filho JE. Do perineal exercises during pregnancy prevent the development of urinary incontinence? A systematic review. Int J Urol. 2008;15(10):875–80.PubMedGoogle Scholar
  70. 70.
    Jain S, Bhartiya N. Positive effects of antenatal yoga on pregnancy outcomes. Ind Obstet Gynaecol. 2017;7(4):27–31.Google Scholar
  71. 71.
    Riley K, Drake E. The effects of prenatal yoga on birth outcomes: a systematic review of the literature. J Prenat Perinat Psychol Health. 2013;28(1):3–19.Google Scholar
  72. 72.
    Jiang Q, Wu Z, Zhou L, Dunlop J, Chen P. Effects of yoga intervention during pregnancy: a review for current status. Am J Perinatol. 2015;32(6):503–14.Google Scholar
  73. 73.
    Muller A, Hammill H. The effect of pilates and progressive muscle relaxation therapy (Mrt) on stress and anxiety during pregnancy: a literature review. S Afr J Sports Med. 2015;27:53.Google Scholar
  74. 74.
    Mazzarino M, Kerr D, Wajswelner H, Morris ME. Pilates method for women’s health: systematic review of randomized controlled trials. Arch Phys Med Rehabil. 2015;96(12):2231–42.PubMedGoogle Scholar
  75. 75.
    Worska A, Szumilewicz A. Physical activity of expecting mothers in the awareness of future exercise professionals. J Educ Health Sport. 2015;5(8):91–102.Google Scholar
  76. 76.
    Schmidt T, Heilmann T, Savelsberg L, Maass N, Weisser B, Eckmann-Scholz C. Physical exercise during pregnancy – how active are pregnant women in Germany and how well informed? Geburtshilfe Frauenheilkd. 2017;77(5):508–15.PubMedPubMedCentralGoogle Scholar
  77. 77.
    Jukic AMZ, Evenson KR, Herring AH, Wilcox AJ, Hartmann KE, Daniels JL. Correlates of physical activity at two time points during pregnancy. J Phys Act Health. 2012;9(3):325–35.PubMedCentralGoogle Scholar
  78. 78.
    Padmanabhan U, Summerbell CD, Heslehurst N. A qualitative study exploring pregnant women’s weight-related attitudes and beliefs in UK: the BLOOM study. BMC Pregnancy Childbirth. 2015;15:99.PubMedPubMedCentralGoogle Scholar
  79. 79.
    Watson ED, Oddie B, Constantinou D. Exercise during pregnancy: knowledge and beliefs of medical practitioners in South Africa: a survey study. BMC Pregnancy Childbirth. 2015;15Google Scholar
  80. 80.
    Malta MB, Carvalhaes M, Takito MY, Tonete VLP, Barros AJD, Parada C, et al. Educational intervention regarding diet and physical activity for pregnant women: changes in knowledge and practices among health professionals. BMC Pregnancy Childbirth. 2016;16:245.Google Scholar
  81. 81.
    CSEP, editor. PARmed-X for PREGNANCY (physical activity readiness medical examination for pregnancy). In: CSfEP, editor. Chicago, IL: CSEP; 2013.Google Scholar
  82. 82.
    Szumilewicz A, Wojtyla A, Zarebska A, Drobnik-Kozakiewicz I, Sawczyn M, Kwitniewska A. Influence of prenatal physical activity on the course of labour and delivery according to the new Polish standard for perinatal care. Ann Agric Environ Med. 2013;20(2):380–9.PubMedGoogle Scholar
  83. 83.
    Evenson KR, Pompeii LA. Obstetrician practice patterns and recommendations for physical activity during pregnancy. J Womens Health (Larchmt). 2010;19(9):1733–40.Google Scholar
  84. 84.
    Hammer RL, Perkins J, Parr R. Exercise during the childbearing year. J Perinat Educ. 2000;9(1):1–14.PubMedPubMedCentralGoogle Scholar
  85. 85.
    O'Connor PJ, Poudevigne MS, Cress ME, Moti RW, Clapp IIIJF. Safety and efficacy of supervised strength training adopted in pregnancy. J Phys Act Health. 2011;8(3):309–20.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Sangsawang B, Serisathien Y. Effect of pelvic floor muscle exercise programme on stress urinary incontinence among pregnant women. J Adv Nurs. 2012;68(9):1997–2007.PubMedGoogle Scholar
  87. 87.
    Pivarnik JM, Mudd L. Oh baby! Exercise during pregnancy and the postpartum period. ACSM’s Health Fitness J. 2009;13(3):8–13.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Anna Szumilewicz
    • 1
    Email author
  • Aneta Worska
    • 1
  • Rita Santos-Rocha
    • 2
    • 3
  • Miguel Ángel Oviedo-Caro
    • 4
  1. 1.Faculty of Tourism and RecreationGdansk University of Physical Education and SportGdańskPoland
  2. 2.Sport Sciences School of Rio MaiorPolytechnic Institute of SantarémRio MaiorPortugal
  3. 3.Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human KineticsUniversity of LisbonCruz Quebrada-DafundoPortugal
  4. 4.University Pablo de OlavideSevillaSpain

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