For clinicians

Exercise and physical activity

physical activity, prenatal exercise

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Bottom lineBottom line: anchor advice to the 2019 SOGC/CSEP Canadian guideline (>=150 min/week moderate activity over >=3 days, aerobic plus resistance, pelvic floor training). Benefits include reduced gestational diabetes, pre-eclampsia, and excessive gestational weight gain, plus mood benefit. Overlay rheumatic-disease modification: joint protection, fatigue pacing, and flare-aware scaling. Screen for absolute and relative contraindications.

In practice

How much, and what kind ●●●●high evidencestrong

2019 Canadian (SOGC/CSEP) guideline (verified): accumulate at least 150 minutes of moderate-intensity activity weekly (Strong, moderate-quality), over at least 3 days/week with daily activity encouraged (Strong, moderate). Incorporate a variety of aerobic and resistance training; yoga and gentle stretching may help (Strong, high-quality). Use the talk test or pregnancy-specific target heart-rate zones for intensity.^[1]

Why it helps ●●●○moderate evidencestrong

2019 Canadian guideline (verified): prenatal activity was associated with reduced odds of gestational diabetes (38%), pre-eclampsia (41%), gestational hypertension (39%), prenatal depression (67%), and macrosomia (39%), without increasing preterm birth, low birth weight, miscarriage, or perinatal mortality. First-trimester activity did not increase miscarriage or congenital anomalies. Prenatal activity also reduces excessive gestational weight gain and lumbopelvic pain.^[1]

If you have a rheumatic disease ●●○○low evidenceconditional

Individualise with joint protection, low-impact modalities, and fatigue pacing; maintain activity through disease fluctuation with flare-aware scaling rather than cessation. Coordinate with physiotherapy and the rheumatology team.^[1]

When to check first or stop ●●●○moderate evidencestrong

2019 Canadian guideline (verified): absolute contraindications include ruptured membranes, premature labour, unexplained persistent vaginal bleeding, placenta praevia after 28 weeks, pre-eclampsia, incompetent cervix, IUGR, high-order multiple pregnancy, and uncontrolled type 1 diabetes, hypertension, or thyroid disease. Reasons to stop and seek care: persistent excessive dyspnoea unresolved by rest, severe chest pain, regular painful uterine contractions, vaginal bleeding, persistent fluid loss, or persistent dizziness/faintness. Advise avoiding the supine position if it provokes symptoms (Weak, very-low).^[1]

Key points

Point	Evidence
The 150 min/week target (aerobic plus resistance) is the guideline anchor, individualised in rheumatic disease.^[1]	●●●○moderate evidencestrong
Flare-aware scaling preserves activity benefits through disease fluctuation.^[1]	●●○○low evidenceconditional

Key numbers

2019 Canadian guideline: >=150 min/week moderate-intensity activity over >=3 days (Strong, moderate-quality).^[1]
2019 Canadian guideline: prenatal activity associated with ~41% reduced odds of pre-eclampsia (and ~38% GDM, ~39% gestational hypertension).^[1]

References

Mottola MF, Davenport MH, Ruchat S-M, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339-1346. https://doi.org/10.1136/bjsports-2018-100056
Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation Guideline for the Treatment of Psoriatic Arthritis. Arthritis Care Res (Hoboken). 2019;71(1):2-29. https://doi.org/10.1002/acr.23789