Risk assessment for physical activity and exercise clearance In pregnant women without contraindications

Traditionally, exercise was advised with caution or not recommended for pregnant women. Women active before pregnancy were advised by physicians to reduce their habitual exercise levels, while previously inactive women were advised to refrain from initiating exercise programs.1 However, guidelines for exercise during pregnancy have evolved substantially during the past 30 years; recommendations have become less restrictive as evidence-based information becomes more readily available.2 Moreover, an increasing number of pregnant women wish to maintain prepregnancy physical fitness levels during the prenatal period, and others wish to initiate exercise for healthier pregnancies.2,3 The conservative nature of medical advice in the past was intended to safeguard the health of both the mother and the growing fetus.2,3 Advice was intentionally conservative because of concern that exercise might shift oxygenated blood and energy substrates away from the fetus to maternal skeletal muscle, as well as increase core body temperature during vulnerable developmental periods such as embryogenesis. Therefore, it was largely unknown whether exercise increased the risk of congenital abnormalities and caused disturbances in optimal fetal growth.2 There were also maternal concerns that excessive exercise might cause conditions such as chronic fatigue and hypoglycemia, or increase the risk of injury (eg, low back pain, musculoskeletal injury).4,5 A more contemporary view of exercise during pregnancy emphasizes that women and their care providers need to consider the risks of not participating in regular physical activities during the prenatal period.3 Previous work in prenatal exercise did not systematically evaluate the prevalence of adverse exercise-related events. This article provides an executive summary of findings from a systematic review of the risks of physical activity for pregnant women without contraindications.6 It is one in a comprehensive series about the risks of physical activity participation in patients with various medical conditions.7 The overall purpose of these systematic reviews was to provide evidence-based recommendations for tools to simplify exercise clearance and prescription: the new Physical Activity Readiness Questionnaire for Everyone (PAR-Q+)8 and the electronic Physical Activity Readiness Medical Examination (ePARmed-X+).9 The purpose of this summary is to present evidence-based information regarding adverse exercise-related events during uncomplicated pregnancy and discuss this information in relation to the family physician’s task of screening patients for physical activity participation