The document provides guidelines for exercise during pregnancy from the American College of Obstetricians and Gynecologists (ACOG). It recommends regular mild to moderate exercise at least 3 times per week that avoids jerky movements. Vigorous exercise should include warm-ups and cool-downs and the heart rate should not exceed 140 bpm for more than 15 minutes. Certain medical conditions are absolute or relative contraindications to exercise during pregnancy. Women should monitor for signs of distress like changes in vaginal bleeding, swelling, or changes in fetal movement. While exercise may pose some risks to maternal health and fetal development, for many women moderate regular exercise is safe during pregnancy.

1. Guidelines for
Women Exercising during
Pregnancy
By Annie Blessie
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2. CONTENTS
 ACOG Guidelines
 Contraindications
 Signs and symptom
 Risk : - maternal and foetal
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3. ACOG guidelines for exercise
 Jerky, bouncing, ballistic movements and activities should be avoided.
 Regular mild to moderate exercise sessions, at least three times a week, are safer than intermittent bursts of activity.
 A careful ‘warm-up’ should precede vigorous exercise, which must always be followed by a ‘cool-down’ or gradual decline in
activity.
 Flexibility and mobility follow the warm-up section, avoiding ballistic stretching. All main muscle groups should be included and
positions stretching at the extreme range of movement avoided.
 Strenuous exercise must be avoided in hot, humid weather, or when the pregnant woman is pyrexial.
 The maternal heart rate should not exceed 140 b.p.m. and vigorous exercise should not continue for longer than 15 minutes.
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4.  An aerobic component should be in the mode best suited to the individual, using large muscle groups and being rhythmical in
nature, i.e. brisk walking, cycling, aerobic dance – all avoiding high impact.
 Avoid supine positions after the first trimester.
 Avoid standing motionless for long periods of time
 As with women beginning exercise outside pregnancy, it is essential that those accustomed to a sedentary lifestyle should start
with low intensity physical activity.
 Walking, swimming, stationary bicycling or yoga are probably ideal, with gradual increases in activity levels according to a
woman’s own individual tolerance capacity.
 Exercise should be decided by the limitations imposed by pregnancy.
 Fluid must be taken before, during and after exertion to avoid dehydration, and energy intake must be sufficient for the needs of
pregnancy as well as the exercise.
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5. Absolute Contraindications
 Cardiovascular disease
 Acute infection
 A history of recurrent
spontaneous abortion
(miscarriage)
 Preterm labour in current or
previous pregnancy
 Multiple pregnancy
 Vaginal bleeding or ruptured
membranes
 Suspected IUGR or foetal
distress
 Thrombophlebitis or pulmonary
embolism
 Chronic hypertension, active
thyroid, cardiac, vascular or
pulmonary disease
 Diabetes type 1 uncontrolled
 Incompentent cervix
 Pregnancy-induced hypertension
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6. Relative Contraindications
 Women unused to high levels of
exertion
 Blood disorders such as sickle
cell disease and anaemia
 Thyroid disease
 Diabetes – however, a carefully
supervised programme of gentle
exercising may actually benefit
some patients
 Extreme obesity or underweight
 Breech presentation in third
trimester
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7. Signs and Symptoms
 any signs of bloody discharge from the vagina
 any ‘gush’ of fluid from the vagina (premature rupture of membranes)
 sudden swelling of ankles, hands or face
 persistent, severe headaches or visual disturbance, or both; unexplained spell of faintness or
dizziness
 swelling, pain and redness in the calf of one leg
 elevation of pulse rate or blood pressure that persists after exercise, excessive fatigue, palpitations
and chest pain
 persistent contractions (6–8 hours) that may suggest onset of premature labour
 unexpected abdominal pain
 insufficient weight gain (1.0 kg/month during the last two trimesters)
 absence of or reduced foetal movements.
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8. Risk of exercise during pregnancy
• It has long been suggested that women whose lives were filled with hard active
work and who were consequently physically fit tended to have easier labours than
those with a more sedentary lifestyle. Vaughan 1951).
• The physiological changes that occur when a woman exercises, particularly in
aerobic exercise, are primarily to maintain the woman’s internal homeostasis
during the exercise period. When assessing effects of exercise in the pregnant
woman, concerns will be related to the physiological effects on the mother and
effect on foetal well-being
• Maternal risk
• Foetal risk
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9. Maternal risk
• greater risk of musculoskeletal trauma because
of connective tissue laxity owing to the
secretion of the hormone relaxin
• increased demands on a cardiovascular system
already altered by pregnancy which include an
increase in blood volume, cardiac output and
resting pulse and a decrease in the systemic
vascular resistance
• Hypoglycaemia may arise with maternal
exercising, which could lead to foetal
hypoglycaemia
• there is an increase in both basal metabolic
rate and heat production during pregnancy
with the foetal temperature
• there is an increase in minute ventilation by
almost 50%, which is mainly due to an
increase in tidal volume.
• increase in oxygen uptake with an increase in
oxygen consumption of 10–20%.
• After the first trimester the supine position
should be avoided as it may cause supine
hypotension
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10. Foetal risk
• Foetal distress could occur during
vigorous and prolonged exercise
because of the selective redistribution
of blood flow away from the
splanchnic organs
• The effects of vigorous activity by the
pregnant woman on the foetal heart
rate have shown an increase of 5–15
beats per minute.
• Foetal malformations, arising from the
teratogenic effects of a raised maternal
core temperature during the first
trimester
• Preterm labour, with or without
delivery, is a concern, especially in the
last trimester; the concern is that
exercise may trigger uterine
contractions.
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