ACOG Guidlines Update 2006 Exercise During Pregnancy and the Postpartum Period

DISCLAIMER: The information contained on this site is not meant to replace the advice and recommendations of your doctor and/or midwife. Please consult your caregiver before beginning any exercise program.

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The current Centers for Disease Control and Prevention and American College of Sports Medicine recommendation for exercise, aimed at improving the health and well-being of nonpregnant individuals, suggests that an accumulation of 30 minutes or more of moderate exercise a day should occur on most, if not all day of the week. In the absence of either medical or obstetric complications, pregnant women also can adopt this recommendation.

Given the potential risks, albeit rare, thorough clinical evaluation of each given pregnant woman should be conducted before recommending an exercise program. In the absence of contraindications, pregnant women should be encouraged to engage in regular, moderate intensity physical activity to continue to derive the same associated health benefits during their pregnancies as they did prior to pregnancy.

In general participation in a wide range of recreational activities appears to be safe. The safety of each sport is detetmined largely by the specific movements required by that sport. Participation in recreational sports with a high potentioal for contact, such as ice hockey, soccer and basketball, could result in trauma to both the woman and fetus. Similarly, recreational activities with an increased risk of falling, such as gymnastics, horseback riding, downhill skiing, and vigourous racquet sports have an inherently high risk for trauma in pregnant and nonpregnant women. Those activities with a high risk of falling or for abdominal trauma should be avoided during pregnancy. Sucba diving should be avoided throughout pregnancy because during this activity the fetus is at increased risk for decompression sickness secondary to the inability of the fetal pulmonary circulation to filter bubble formation.

Exertion at altitudes of up to 6.000 feet appears to be safe; however, engaging in physical activities at higher altitudes carries various risks. All women who are recreationally active should be made aware of signs of altitude sickness for which they should stop the exercise, decend from the altitude, and seek medical attention.
Monderate weight reduction while nursing is safe and does not compromise neonatal weight gain. Finally, a return to physical actiivity after pregnancy has been associated with decreased incidence of postpartum depression, but only if the exercise is stress relieving and not stress provoking.
Conclusions and Recommendations

Recreational and competitive athletes with uncomplicated pregnancies can remain active during pregnancy and should modify their usual exercise routines as medically indicated. The information on strenuous exercise is scarce; however, women who engage in such activities require close medical supervision.
Previously inactive women and those with medical or obstetric complications should be evaluated before recommendations for physical activity during pregnancy are made. Exercise during pregnancy may provide additional health benefits to women with gestational diabetes.
A physically active woman with the history of or a risk of preterm labor or fetal growth restriction should be advised to reduce her activity in the second and third trimesters.

Recommendations for Exercise in Pregnancy and Postpartum

Source: American College of Obstetricians and Gynecologists, Home Exercise Programs, Washington, DC, 2002

Women should avoid exercise in the supine position after the first trimester. Such a position is associated with decreased cardiac output in most pregnant women.

Pregnant women who exercise in the first trimester should augment heat dissipation by ensuring adequate hydration, appropriate clothing, and optimal environmental surroundings during exercise.

Many of the physiologic and morphologic changes of pregnancy persist 4-6 weeks postpartum. Thus, prepregnancy exercise routines should be resumed gradually based on a woman's physical capability.

Contraindications to Exercise

The following conditions should be considered contraindications to exercise during pregnancy:

  • Pregnancy-induced hypertension
  • Pre-term rupture of membranes
  • Preterm labor during the prior or current pregnancy or both
  • Incompetent cervix/cerclage
  • Persistent second- or third -trimester bleeding
  • Intrauterine growth retardation

In addition, women with certain other medical or obstetric conditions, including chronic hypertension or active thyroid, cardiac, vascular, or pulmonary disease, should be evaluated carefully in order to determine whether an exercise program is appropriate.

Summary

In the absence of either obstetric or medial complications, pregnant women can continue to exercise and derive related benefits. Women who have achieved cardiovascular fitness prior to pregnancy should be able to safely maintain that level of fitness throughout pregnancy and the postpartum period. Depending on the individual's needs and the physiologic changes associated with pregnancy, women may have to modify their specific exercise regimens. Despite findings that suggest lower birth weights among offspring of women who continue to exercise vigorously throughout pregnancy, there currently are no data to confirm that, with the specific exceptions mentioned here, exercising during pregnancy has any deleterious affects on the fetus. While maternal fitness and sense of well-being may be enhanced by exercise, no level of exercise during pregnancy had been conclusively demonstrated to be beneficial in improving perinatal outcome.


The ACOG Guidelines for Exercise During Pregnancy and Postpartum (1985)

Source: American College of Obstetricians and Gynecologists, Home Exercise Programs, Washington, DC, 1985

Note: The following 1985 guidelines have been superceded by the 1995 guidelines above. The 1985 guidelines are included as a historical reference.

The following guidelines are based on the unique physical and physiological conditions that exist during pregnancy and the postpartum period. They outline general criteria for safety to provide direction to patients in the development of home exercise programs.

Pregnancy and Postpartum

1. Regular exercise (at least 3 times per week) is preferable to intermittent activity. Competitive activities should be discouraged.

2. Vigorous exercise should not be performed in hot, humid weather or during a period of febrile illness.

3. Ballistic movements (jerky, bouncy motions) should be avoided. Exercise should be done on a wooden floor or a tightly carpeted surface to reduce shock and provide a sure footing.

4. Deep flexion or extension of joints should be avoided because of connective tissue laxity. Activities that require jumping, jarring motions or rapid changes in direction should be avoided because of joint instability.

5. Vigorous exercise should be preceded by a 5-minute period of muscle warm-up. This can be accomplished by slow walking or stationary cycling with low resistance.

6. Vigorous exercise should be followed by a period of gradually declining activity that includes gentle stationary stretching. Because connective tissue laxity increases the risk of joint injury, stretches should not be taken to the point of maximum resistance.

7. Heart rate should be measured at times of peak activity. Target heart rates and limits established in consultation with the physician should not be exceeded.

8. Care should be taken to gradually rise from the floor to avoid orthostatic hypotension. Some form of activity involving the legs should be continued for a brief period.

9. Liquids should be taken liberally before and after exercise to prevent dehydration. If necessary, activity should be interrupted t replenish fluids.

10. Women who have led sedentary lifestyles should begin with physical activity of very low intensity and advance activity levels very gradually.

11. Activity should be stopped and the physician consulted if any unusual symptoms appear.

Pregnancy Only

1. Maternal heart rate should not exceed 140 beats per minute. Note: this restriction does not appear in the 1995 guidelines.

2. Strenuous activities should not exceed 15 minutes in duration.

3. No exercise should be performed in the supine position after the fourth month of gestation is completed.

4. Exercises that employ the Valsalva maneuver should be avoided.

5. Caloric intake should be adequate to meet not only the extra energy needs of pregnancy, but also of the exercise performed.

6. Maternal core temperature should not exceed 38 degrees C.

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