Clinical Practice Guidelines Antenatal Care — Module II
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- Levels of physical activity in Australia
- Factors influencing levels of physical activity
- Discussing physical activity
- Practice summary: physical activity
5.4Physical activityRegular low to moderate-intensity physical activity is generally safe during pregnancy with likely benefits for mother and baby. BackgroundPhysical activity can be defined as any body movement that involves the use of one or more large muscle groups and raises the heart rate. This includes sport, exercise and recreational activities and incidental activity that accrues throughout the day (eg walking to the shops, climbing stairs). The Australian National Physical Activity Guidelines recommend at least 30 minutes of moderate-intensity physical activity on most, preferably all, days, for all adults (DoHA 1999). Moderate-intensity activity is that which causes a slight, but noticeable, increase in breathing and heart rate (eg brisk walking, mowing the lawn, digging in the garden, or medium-paced swimming). The National Physical Activity Guidelines recommend against vigorous activity during pregnancy (DoHA 1999). Levels of physical activity in AustraliaData specific to pregnant women are not available but results from national surveys give some indication of patterns of physical activity and sedentary behaviour. The 2007–08 National Health Survey showed that only 38% of adult women exercised sufficiently to obtain health benefits (AIHW 2011), 34% were sedentary (no exercise or very low levels) and physical activity decreased with age — 29% of women aged 15–24 years were sedentary (AIHW 2010). People living outside major cities and in more disadvantaged areas were more likely to be inactive (AIHW 2011). The proportion of people with no or low levels of exercise varied with region of birth — North Africa and the Middle East (91%), South-East Asia (79.1%), Southern and Eastern Europe (74.9%), Australia (71.3%) (AIHW 2010). In the 2004–05 National Aboriginal and Torres Strait Islander Health Survey, 75% of respondents aged 15 years and over living in non-remote areas had sedentary or low levels of physical activity, with women more likely to be sedentary than men (AIHW 2010).
perceptions that being physically active may harm the baby; limited facilities (eg pools, gymnasiums) or infrastructure (eg walking paths), particularly in some rural areas (NRHA 2011); limited access to group activities and/or facilities specifically for women; costs of attending activities; perceptions that being physically active for the sake of it is a waste of time and money; limited time for physical activity due to other commitments (eg looking after other children, working); and perception of personal safety in public places. Discussing physical activitySummary of the evidenceGuidelines in the United States (ACOG 2002), Canada (Davies et al 2003) and the United Kingdom (RCOG 2006) recommend that women be encouraged to participate in physical activity during pregnancy. Benefits of physical activity during pregnancySystematic reviews and RCTs have found that regular physical activity during pregnancy: appears to improve (or maintain) physical fitness (Kramer & McDonald 2006; Ramírez-Vélez et al 2011); improves health-related quality of life (Montoya Arizabaleta et al 2010) and maternal perception of health status (Barakat et al 2011); may reduce depressive symptoms (Robledo-Colonia et al 2012); and can prevent urinary incontinence (pelvic floor muscle training) (Boyle et al 2012). Calculation of BMI at the first antenatal visit (see Module I, Section 7.2) allows appropriate advice about physical activity to be given early in pregnancy. However, the evidence on the effect of physical activity on weight gain during pregnancy is inconsistent: systematic reviews have found: insufficient evidence to recommend any one intervention for preventing excessive weight gain during pregnancy (Muktabhant et al 2012); physical activity alone was only effective in reducing weight gain among women who were overweight or obese (Sui et al 2012); and diet-based interventions were more effective in reducing gestational weight gain than physical activity or a combined intervention (Thangaratinam et al 2012); and RCTs have found that physical activity alone may limit gestational weight gain among women who are overweight or obese (Nascimento et al 2011) and, combined with nutrition intervention, may limit weight gain in women with a pre-pregnancy BMI in the normal range (Ruchat et al 2012) and in the overweight or obese range (Vinter et al 2011). There is insufficient evidence for reliable conclusions about the effect of physical activity on: maternal and fetal outcomes (Kramer & McDonald 2006); preventing gestational diabetes or glucose intolerance in pregnancy (Han et al 2012) or improving glucose tolerance in women with gestational diabetes (Ceysens et al 2006); or preventing pre-eclampsia and its complications (Meher & Duley 2006). RCTs into specific types of physical activity during pregnancy have found: specifically designed exercise programs prevented pelvic girdle pain (n=301)(Morkved et al 2007) and reduced severity of back pain (Kashanian et al 2009); and yoga reduced perceived stress (n=90)(Satyapriya et al 2009), improved quality of life and enhanced interpersonal relationships (n=102)(Rakhshani et al 2010) and women reported less pain during labour (n=74)(Chuntharapat et al 2008). The safety of moderate physical activity during pregnancy is supported by a number of RCTs: walking, joint mobilisation and light resistance exercises (three 35-minute sessions a week in the second and third trimester) (n=160) did not affect fetal cardiovascular responses (Barakat et al 2010), maternal anaemia (Barakat et al 2009a), type of birth (Barakat 2009b), gestational age at birth (Barakat et al 2008) or the newborn’s body size or overall health (Barakat et al 2009c); aerobic dance exercise was not associated with reduction in birth weight, preterm birth rate or neonatal wellbeing (Haakstad & Bø 2011); stationary cycling (up to five 40-minute sessions a week from 20 weeks gestation) (n=84) was associated with normalisation of birth weight (Hopkins et al 2010); and water aerobics (three 50-minute sessions a week from 16–20 weeks gestation) (n=71) was not associated with any alteration in maternal body composition, type of birth, preterm birth rate, neonatal wellbeing or weight (Cavalcante et al 2009). Recommendation 6 Grade B Advise women that low- to moderate-intensity physical activity during pregnancy is associated with a range of health benefits and is not associated with adverse outcomes. Pregnant women should avoid physical activity that involves the risk of abdominal trauma, falls or excessive joint stress, such as in high impact sports, contact sports and vigorous racquet sports (NICE 2008). They are also recommended not to scuba dive, because the risk of birth defects seems to be greater among those who do, and there is a serious risk of fetal decompression disease (Camporesi 1996). Practice summary: physical activity
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