Skip to main content
PMC home page
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2003 Feb;37(1):6–12. doi: 10.1136/bjsm.37.1.6

Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period

R Artal 1, M O'Toole 1, S White 1
PMCID: PMC1724598  PMID: 12547738

Full Text

The Full Text of this article is available as a PDF (118.5 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahlborg G., Jr, Bodin L., Hogstedt C. Heavy lifting during pregnancy--a hazard to the fetus? A prospective study. Int J Epidemiol. 1990 Mar;19(1):90–97. doi: 10.1093/ije/19.1.90. [DOI] [PubMed] [Google Scholar]
  2. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc. 1998 Jun;30(6):975–991. doi: 10.1097/00005768-199806000-00032. [DOI] [PubMed] [Google Scholar]
  3. Artal R. Exercise and diabetes mellitus in pregnancy. A brief review. Sports Med. 1990 May;9(5):261–265. doi: 10.2165/00007256-199009050-00001. [DOI] [PubMed] [Google Scholar]
  4. Artal R., Fortunato V., Welton A., Constantino N., Khodiguian N., Villalobos L., Wiswell R. A comparison of cardiopulmonary adaptations to exercise in pregnancy at sea level and altitude. Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1170–1180. doi: 10.1016/0002-9378(95)91475-7. [DOI] [PubMed] [Google Scholar]
  5. Artal R., Masaki D. I., Khodiguian N., Romem Y., Rutherford S. E., Wiswell R. A. Exercise prescription in pregnancy: weight-bearing versus non-weight-bearing exercise. Am J Obstet Gynecol. 1989 Dec;161(6 Pt 1):1464–1469. doi: 10.1016/0002-9378(89)90905-8. [DOI] [PubMed] [Google Scholar]
  6. Artal R., Platt L. D., Sperling M., Kammula R. K., Jilek J., Nakamura R. I. Maternal cardiovascular and metabolic responses in normal pregnancy. Am J Obstet Gynecol. 1981 May 15;140(2):123–127. [PubMed] [Google Scholar]
  7. Artal R., Wiswell R., Romem Y., Dorey F. Pulmonary responses to exercise in pregnancy. Am J Obstet Gynecol. 1986 Feb;154(2):378–383. doi: 10.1016/0002-9378(86)90675-7. [DOI] [PubMed] [Google Scholar]
  8. Berry M. J., McMurray R. G., Katz V. L. Pulmonary and ventilatory responses to pregnancy, immersion, and exercise. J Appl Physiol (1985) 1989 Feb;66(2):857–862. doi: 10.1152/jappl.1989.66.2.857. [DOI] [PubMed] [Google Scholar]
  9. Blair S. N., Kohl H. W., Gordon N. F., Paffenbarger R. S., Jr How much physical activity is good for health? Annu Rev Public Health. 1992;13:99–126. doi: 10.1146/annurev.pu.13.050192.000531. [DOI] [PubMed] [Google Scholar]
  10. Bung P., Artal R. Gestational diabetes and exercise: a survey. Semin Perinatol. 1996 Aug;20(4):328–333. doi: 10.1016/s0146-0005(96)80025-5. [DOI] [PubMed] [Google Scholar]
  11. Bung P., Artal R., Khodiguian N., Kjos S. Exercise in gestational diabetes. An optional therapeutic approach? Diabetes. 1991 Dec;40 (Suppl 2):182–185. doi: 10.2337/diab.40.2.s182. [DOI] [PubMed] [Google Scholar]
  12. Calguneri M., Bird H. A., Wright V. Changes in joint laxity occurring during pregnancy. Ann Rheum Dis. 1982 Apr;41(2):126–128. doi: 10.1136/ard.41.2.126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Camporesi E. M. Diving and pregnancy. Semin Perinatol. 1996 Aug;20(4):292–302. doi: 10.1016/s0146-0005(96)80022-x. [DOI] [PubMed] [Google Scholar]
  14. Carpenter M. W., Sady S. P., Hoegsberg B., Sady M. A., Haydon B., Cullinane E. M., Coustan D. R., Thompson P. D. Fetal heart rate response to maternal exertion. JAMA. 1988 May 27;259(20):3006–3009. [PubMed] [Google Scholar]
  15. Clapp J. F., 3rd, Capeless E. L. Neonatal morphometrics after endurance exercise during pregnancy. Am J Obstet Gynecol. 1990 Dec;163(6 Pt 1):1805–1811. doi: 10.1016/0002-9378(90)90754-u. [DOI] [PubMed] [Google Scholar]
  16. Clapp J. F., 3rd Fetal heart rate response to running in midpregnancy and late pregnancy. Am J Obstet Gynecol. 1985 Oct 1;153(3):251–252. doi: 10.1016/s0002-9378(85)80106-x. [DOI] [PubMed] [Google Scholar]
  17. Clapp J. F., 3rd Oxygen consumption during treadmill exercise before, during, and after pregnancy. Am J Obstet Gynecol. 1989 Dec;161(6 Pt 1):1458–1464. doi: 10.1016/0002-9378(89)90904-6. [DOI] [PubMed] [Google Scholar]
  18. Clapp J. F., 3rd, Seaward B. L., Sleamaker R. H., Hiser J. Maternal physiologic adaptations to early human pregnancy. Am J Obstet Gynecol. 1988 Dec;159(6):1456–1460. doi: 10.1016/0002-9378(88)90574-1. [DOI] [PubMed] [Google Scholar]
  19. Clark S. L., Cotton D. B., Lee W., Bishop C., Hill T., Southwick J., Pivarnik J., Spillman T., DeVore G. R., Phelan J. Central hemodynamic assessment of normal term pregnancy. Am J Obstet Gynecol. 1989 Dec;161(6 Pt 1):1439–1442. doi: 10.1016/0002-9378(89)90900-9. [DOI] [PubMed] [Google Scholar]
  20. Clark S. L., Cotton D. B., Pivarnik J. M., Lee W., Hankins G. D., Benedetti T. J., Phelan J. P. Position change and central hemodynamic profile during normal third-trimester pregnancy and post partum. Am J Obstet Gynecol. 1991 Mar;164(3):883–887. doi: 10.1016/s0002-9378(11)90534-1. [DOI] [PubMed] [Google Scholar]
  21. Collings C. A., Curet L. B., Mullin J. P. Maternal and fetal responses to a maternal aerobic exercise program. Am J Obstet Gynecol. 1983 Mar 15;145(6):702–707. doi: 10.1016/0002-9378(83)90576-8. [DOI] [PubMed] [Google Scholar]
  22. Dye T. D., Knox K. L., Artal R., Aubry R. H., Wojtowycz M. A. Physical activity, obesity, and diabetes in pregnancy. Am J Epidemiol. 1997 Dec 1;146(11):961–965. doi: 10.1093/oxfordjournals.aje.a009223. [DOI] [PubMed] [Google Scholar]
  23. Edwards M. J. Hyperthermia as a teratogen: a review of experimental studies and their clinical significance. Teratog Carcinog Mutagen. 1986;6(6):563–582. doi: 10.1002/tcm.1770060610. [DOI] [PubMed] [Google Scholar]
  24. Epstein M., Loutzenhiser R., Friedland E., Aceto R. M., Camargo M. J., Atlas S. A. Relationship of increased plasma atrial natriuretic factor and renal sodium handling during immersion-induced central hypervolemia in normal humans. J Clin Invest. 1987 Mar;79(3):738–745. doi: 10.1172/JCI112879. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Erkkola R. U., Pirhonen J. P., Kivijärvi A. K. Flow velocity waveforms in uterine and umbilical arteries during submaximal bicycle exercise in normal pregnancy. Obstet Gynecol. 1992 Apr;79(4):611–615. [PubMed] [Google Scholar]
  26. Grisso J. A., Main D. M., Chiu G., Synder E. S., Holmes J. H. Effects of physical activity and life-style factors on uterine contraction frequency. Am J Perinatol. 1992 Sep-Nov;9(5-6):489–492. doi: 10.1055/s-2007-999295. [DOI] [PubMed] [Google Scholar]
  27. Hale R. W., Milne L. The elite athlete and exercise in pregnancy. Semin Perinatol. 1996 Aug;20(4):277–284. doi: 10.1016/s0146-0005(96)80020-6. [DOI] [PubMed] [Google Scholar]
  28. Hall D. C., Kaufmann D. A. Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol. 1987 Nov;157(5):1199–1203. doi: 10.1016/s0002-9378(87)80294-6. [DOI] [PubMed] [Google Scholar]
  29. Hatch M. C., Shu X. O., McLean D. E., Levin B., Begg M., Reuss L., Susser M. Maternal exercise during pregnancy, physical fitness, and fetal growth. Am J Epidemiol. 1993 May 15;137(10):1105–1114. doi: 10.1093/oxfordjournals.aje.a116614. [DOI] [PubMed] [Google Scholar]
  30. Hollingsworth D. R., Moore T. R. Postprandial walking exercise in pregnant insulin-dependent (type I) diabetic women: reduction of plasma lipid levels but absence of a significant effect on glycemic control. Am J Obstet Gynecol. 1987 Dec;157(6):1359–1363. doi: 10.1016/s0002-9378(87)80224-7. [DOI] [PubMed] [Google Scholar]
  31. Huch R. Physical activity at altitude in pregnancy. Semin Perinatol. 1996 Aug;20(4):303–314. doi: 10.1016/s0146-0005(96)80023-1. [DOI] [PubMed] [Google Scholar]
  32. Jovanovic-Peterson L., Durak E. P., Peterson C. M. Randomized trial of diet versus diet plus cardiovascular conditioning on glucose levels in gestational diabetes. Am J Obstet Gynecol. 1989 Aug;161(2):415–419. doi: 10.1016/0002-9378(89)90534-6. [DOI] [PubMed] [Google Scholar]
  33. Jovanovic-Peterson L., Peterson C. M. Exercise and the nutritional management of diabetes during pregnancy. Obstet Gynecol Clin North Am. 1996 Mar;23(1):75–86. doi: 10.1016/s0889-8545(05)70245-x. [DOI] [PubMed] [Google Scholar]
  34. Jovanovic L. American Diabetes Association's Fourth International Workshop-Conference on Gestational Diabetes Mellitus: summary and discussion. Therapeutic interventions. Diabetes Care. 1998 Aug;21 (Suppl 2):B131–B137. [PubMed] [Google Scholar]
  35. Katz V. L., McMurray R., Berry M. J., Cefalo R. C. Fetal and uterine responses to immersion and exercise. Obstet Gynecol. 1988 Aug;72(2):225–230. [PubMed] [Google Scholar]
  36. Koltyn K. F., Schultes S. S. Psychological effects of an aerobic exercise session and a rest session following pregnancy. J Sports Med Phys Fitness. 1997 Dec;37(4):287–291. [PubMed] [Google Scholar]
  37. Kulpa P. J., White B. M., Visscher R. Aerobic exercise in pregnancy. Am J Obstet Gynecol. 1987 Jun;156(6):1395–1403. doi: 10.1016/0002-9378(87)90006-8. [DOI] [PubMed] [Google Scholar]
  38. Launer L. J., Villar J., Kestler E., de Onis M. The effect of maternal work on fetal growth and duration of pregnancy: a prospective study. Br J Obstet Gynaecol. 1990 Jan;97(1):62–70. doi: 10.1111/j.1471-0528.1990.tb01718.x. [DOI] [PubMed] [Google Scholar]
  39. Lokey E. A., Tran Z. V., Wells C. L., Myers B. C., Tran A. C. Effects of physical exercise on pregnancy outcomes: a meta-analytic review. Med Sci Sports Exerc. 1991 Nov;23(11):1234–1239. [PubMed] [Google Scholar]
  40. Lotgering F. K., van Doorn M. B., Struijk P. C., Pool J., Wallenburg H. C. Maximal aerobic exercise in pregnant women: heart rate, O2 consumption, CO2 production, and ventilation. J Appl Physiol (1985) 1991 Mar;70(3):1016–1023. doi: 10.1152/jappl.1991.70.3.1016. [DOI] [PubMed] [Google Scholar]
  41. McCrory M. A., Nommsen-Rivers L. A., Molé P. A., Lönnerdal B., Dewey K. G. Randomized trial of the short-term effects of dieting compared with dieting plus aerobic exercise on lactation performance. Am J Clin Nutr. 1999 May;69(5):959–967. doi: 10.1093/ajcn/69.5.959. [DOI] [PubMed] [Google Scholar]
  42. McDonald A. D., McDonald J. C., Armstrong B., Cherry N. M., Nolin A. D., Robert D. Prematurity and work in pregnancy. Br J Ind Med. 1988 Jan;45(1):56–62. doi: 10.1136/oem.45.1.56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. McMurray R. G., Hackney A. C., Katz V. L., Gall M., Watson W. J. Pregnancy-induced changes in the maximal physiological responses during swimming. J Appl Physiol (1985) 1991 Oct;71(4):1454–1459. doi: 10.1152/jappl.1991.71.4.1454. [DOI] [PubMed] [Google Scholar]
  44. McMurray R. G., Mottola M. F., Wolfe L. A., Artal R., Millar L., Pivarnik J. M. Recent advances in understanding maternal and fetal responses to exercise. Med Sci Sports Exerc. 1993 Dec;25(12):1305–1321. [PubMed] [Google Scholar]
  45. Milunsky A., Ulcickas M., Rothman K. J., Willett W., Jick S. S., Jick H. Maternal heat exposure and neural tube defects. JAMA. 1992 Aug 19;268(7):882–885. [PubMed] [Google Scholar]
  46. Morrow R. J., Ritchie J. W., Bull S. B. Fetal and maternal hemodynamic responses to exercise in pregnancy assessed by Doppler ultrasonography. Am J Obstet Gynecol. 1989 Jan;160(1):138–140. doi: 10.1016/0002-9378(89)90106-3. [DOI] [PubMed] [Google Scholar]
  47. Morton M. J., Paul M. S., Campos G. R., Hart M. V., Metcalfe J. Exercise dynamics in late gestation: effects of physical training. Am J Obstet Gynecol. 1985 May 1;152(1):91–97. doi: 10.1016/s0002-9378(85)80187-3. [DOI] [PubMed] [Google Scholar]
  48. Naeye R. L., Peters E. C. Working during pregnancy: effects on the fetus. Pediatrics. 1982 Jun;69(6):724–727. [PubMed] [Google Scholar]
  49. PROWSE C. M., GAENSLER E. A. RESPIRATORY AND ACID-BASE CHANGES DURING PREGNANCY. Anesthesiology. 1965 Jul-Aug;26:381–392. doi: 10.1097/00000542-196507000-00003. [DOI] [PubMed] [Google Scholar]
  50. Pate R. R., Pratt M., Blair S. N., Haskell W. L., Macera C. A., Bouchard C., Buchner D., Ettinger W., Heath G. W., King A. C. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995 Feb 1;273(5):402–407. doi: 10.1001/jama.273.5.402. [DOI] [PubMed] [Google Scholar]
  51. Pivarnik J. M. Cardiovascular responses to aerobic exercise during pregnancy and postpartum. Semin Perinatol. 1996 Aug;20(4):242–249. doi: 10.1016/s0146-0005(96)80017-6. [DOI] [PubMed] [Google Scholar]
  52. Pivarnik J. M., Lee W., Clark S. L., Cotton D. B., Spillman H. T., Miller J. F. Cardiac output responses of primigravid women during exercise determined by the direct Fick technique. Obstet Gynecol. 1990 Jun;75(6):954–959. [PubMed] [Google Scholar]
  53. Pivarnik J. M., Lee W., Spillman T., Clark S. L., Cotton D. B., Miller J. F. Maternal respiration and blood gases during aerobic exercise performed at moderate altitude. Med Sci Sports Exerc. 1992 Aug;24(8):868–872. [PubMed] [Google Scholar]
  54. Pivarnik J. M. Maternal exercise during pregnancy. Sports Med. 1994 Oct;18(4):215–217. doi: 10.2165/00007256-199418040-00001. [DOI] [PubMed] [Google Scholar]
  55. Sady S. P., Carpenter M. W., Thompson P. D., Sady M. A., Haydon B., Coustan D. R. Cardiovascular response to cycle exercise during and after pregnancy. J Appl Physiol (1985) 1989 Jan;66(1):336–341. doi: 10.1152/jappl.1989.66.1.336. [DOI] [PubMed] [Google Scholar]
  56. Saurel-Cubizolles M. J., Kaminski M. Pregnant women's working conditions and their changes during pregnancy: a national study in France. Br J Ind Med. 1987 Apr;44(4):236–243. doi: 10.1136/oem.44.4.236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Soultanakis H. N., Artal R., Wiswell R. A. Prolonged exercise in pregnancy: glucose homeostasis, ventilatory and cardiovascular responses. Semin Perinatol. 1996 Aug;20(4):315–327. doi: 10.1016/s0146-0005(96)80024-3. [DOI] [PubMed] [Google Scholar]
  58. Sternfeld B., Quesenberry C. P., Jr, Eskenazi B., Newman L. A. Exercise during pregnancy and pregnancy outcome. Med Sci Sports Exerc. 1995 May;27(5):634–640. [PubMed] [Google Scholar]
  59. Templeton A., Kelman G. R. Maternal blood-gases, PAo2--Pao2), hysiological shunt and VD/VT in normal pregnancy. Br J Anaesth. 1976 Oct;48(10):1001–1004. doi: 10.1093/bja/48.10.1001. [DOI] [PubMed] [Google Scholar]
  60. Veille J. C., Hohimer A. R., Burry K., Speroff L. The effect of exercise on uterine activity in the last eight weeks of pregnancy. Am J Obstet Gynecol. 1985 Mar 15;151(6):727–730. doi: 10.1016/0002-9378(85)90505-8. [DOI] [PubMed] [Google Scholar]
  61. Wolfe L. A., Ohtake P. J., Mottola M. F., McGrath M. J. Physiological interactions between pregnancy and aerobic exercise. Exerc Sport Sci Rev. 1989;17:295–351. [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES