Prescription of aerobic exercise during pregnancy

Available evidence supports the existence of both risks and benefits of aerobic conditioning during human pregnancy. During intensive exertion, maternal skeletal muscle and the fetus may compete for blood flow, oxygen delivery and essential fuel substrates. Hence, the most important hypothetical risks include acute fetal hypoxia, hyperthermia and malnutrition. If exercise is repeated on a chronic basis, teratogenic effects, fetal growth retardation or altered fetal development may result if maternal/fetal adaptive reserve is exceeded. A dose-response relationship for such effects has been demonstrated in laboratory animals, but specific findings may have limited applicability to voluntary exercise in pregnant women. Although further investigation is needed, the majority of published studies suggest that fitness-type conditioning does not jeopardise fetal well-being in healthy well-nourished women. Benefits of such exercise appear to include increases in maximal aerobic power (VO2max, L/min) and enhanced cardiopulmonary reserve. It has also been proposed that exercise prevents accumulation of excess body fat, promotes psychological well-being, helps to prevent gestational diabetes and low back pain and may facilitate labour. However, these benefits remain to be confirmed by objective scientific study. Due primarily to a lack of scientific data, existing medical guidelines for exercise during pregnancy are conservative and follow a common sense approach. Good agreement exists on the need for preparticipation medical screening and continuing surveillance to verify the existence of maternal/fetal adaptive reserve. Women are advised to select safe, non-ballistic exercise modalities and to avoid thermal or hyperbaric environmental stress during exercise. Exercise in the supine position is also prudent to avoid, particularly in late gestation. The usefulness of heart rate in prescribing and monitoring exercise intensity has been questioned, with use of conventional perception of exertion scales being the most logical alternative. Prediction of maximal aerobic power (VO2max) from submaximal work rate/heart rate relationships is also problematic during pregnancy. Other areas of debate include the advisability of initiating a new exercise programme during pregnancy, methods for prevention of fetal hyperthermia, the safety of weight-training/isometric exercise and optimal methods for training of pre/postnatal fitness instructors.