Exercise During Pregnancy: Evidence-Based Guidance for Safe Movement by Kathryn Melvin Women's Health APA Physiotherapist

Staying active during pregnancy offers significant benefits for both mother and baby. As physiotherapists, we play a key role in guiding safe, effective exercise tailored to each individual. This blog outlines current recommendations, including guidance from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and highlights evidence from recent systematic reviews.

Why Exercise Matters in Pregnancy

Regular physical activity during pregnancy is associated with:

  • Reduced risk of gestational diabetes

  • Lower incidence of hypertensive disorders (including preeclampsia)

  • Improved mental health and reduced symptoms of anxiety and depression

  • Better weight management

  • Reduced risk of excessive fetal growth (macrosomia)

  • Shorter labour and reduced likelihood of operative delivery

Importantly, exercise is considered safe for most uncomplicated pregnancies.

RANZCOG Guidelines: Key Recommendations

According to RANZCOG:

  • Duration & Frequency:

    Aim for 150–300 minutes of moderate-intensity physical activity per week, spread over most days.

  • Intensity:

    Moderate intensity is recommended. A practical guide is the “talk test” - you should be able to maintain a conversation while exercising.

  • Type of Exercise:

    A combination of:

    • Aerobic activity (e.g., walking, swimming, cycling)

    • Strength training (light-to-moderate resistance)

    • Pelvic floor muscle training (essential throughout pregnancy)

  • Progression:

    Women who were previously inactive should begin gradually, while those already active can usually continue with modifications.

What to Avoid

RANZCOG advises avoiding:

  • Contact sports or activities with risk of abdominal trauma

  • High-risk activities for falls (e.g., skiing, horse riding)

  • Scuba diving

  • Exercising in excessive heat or humidity

  • Prolonged supine exercise after the first trimester (due to vena cava compression)

When to Modify or Stop Exercise

Patients should be advised to stop exercise and seek medical review if they experience:

  • Vaginal bleeding

  • Dizziness or faintness

  • Chest pain

  • Regular painful contractions

  • Reduced fetal movement

  • Amniotic fluid leakage

Contraindications to Exercise

Absolute contraindications include:

  • Significant heart or lung disease

  • Cervical insufficiency

  • Multiple pregnancy at risk of preterm labour

  • Persistent second or third trimester bleeding

  • Placenta previa after 28 weeks

Relative contraindications should be assessed on a case-by-case basis.

What Does Recent Evidence Say?

A 2020 systematic review and meta-analysis by Davenport et al. (within the past five years) reinforces the safety and benefits of prenatal exercise. Key findings include:

  • No increased risk of miscarriage, preterm birth, or low birth weight

  • Significant reduction in risk of gestational diabetes and hypertensive disorders

  • Improvements in maternal fitness and psychological wellbeing

The review supports moderate-intensity exercise as both safe and beneficial across all trimesters in uncomplicated pregnancies.

Role of Physiotherapy

Physiotherapists are uniquely positioned to:

  • Assess individual risk factors and tailor exercise programs

  • Provide guidance on pelvic floor training and core stability

  • Manage pregnancy-related musculoskeletal pain (e.g., pelvic girdle pain, low back pain)

  • Educate patients on safe movement patterns and posture

Practical Tips for Patients

  • Start slow and build gradually

  • Stay hydrated and avoid overheating

  • Wear supportive footwear and clothing

  • Incorporate pelvic floor exercises daily

  • Listen to your body—fatigue is a signal to rest

Final Thoughts

Exercise during pregnancy is not only safe for most women—it is strongly encouraged. Following evidence-based guidelines such as those from RANZCOG ensures both maternal and fetal wellbeing are prioritised.

If you are pregnant or planning pregnancy, consult a physiotherapist or healthcare provider

to develop a personalised exercise plan that suits your needs.

References:

  • RANZCOG. Exercise during pregnancy (latest guideline)

  • Davenport MH et al. (2020). Impact of prenatal exercise on maternal and neonatal outcomes: systematic review and meta-analysis

  • Australian Government Department of Health Physical Activity Guidelines

Stuart McKayComment