Physical activity (PA) during pregnancy promotes beneficial maternal, fetal and neonatal health outcomes including reduced risk of excessive gestational weight gain, preterm birth, gestational diabetes mellitus, pre-eclampsia, and complications related to delivery and in newborn. Despite having these health benefits, there is marked decline in PA during pregnancy. Data from various population-based surveys show that less than 30% of pregnant women meet PA recommendations. Prospective data from another cohort study shows that only 16% of pregnant women report any leisure-time PA, and only 8% of this cohort meeting PA/exercise guidelines following their child birth. Mainly the anatomical and physiological changes, which are associated with fatigue and discomfort, or fear of harm to the developing fetus are attributed to the decline in PA during pregnancy.

Aerobic exercise, resistance training, pelvic floor strengthening all are having a part to play in the entire journey of pregnancy. Most of the recent guidelines advocate 150 min aerobic exercise in the form of walking, cycling or even swimming throughout the week whereas light to moderate strength training is recommended atleast 1-3 session per week. Among the specific exercise pelvic floor muscle training is advised 3 times per day to reduce the risk of urinary incontinence. Additional precautions like proper warm-up, cooling down, adequate hydration need to be taken whenever engaged in any form of PA. Exercise during the first trimester did not increase the odds of miscarriage or congenital anomalies hence PA should be encouraged throughout pregnancy.

Though PA is generally considered safe during pregnancy, few conditions like ruptured membrane, persistent vaginal bleeding etc may warrant precaution and modification of exercise. Inactive women are encouraged to start PA in pregnancy but may need to begin gradually, at lower intensity and increase the duration and intensity as their pregnancy progresses. It is important to note that when dose–response relationships between physical activity and pregnancy outcomes were identified, more physical activity (frequency, intensity, duration and volume) was associated with greater health benefits. However there are very few guidelines providing advice for highly active women or offer safe upper limits relating to intensity and duration, hence more research is needed for elite athletes. Since the participation rates of women in sport are increasing across the world, and many female athletes wish to compete during their childbearing years, this should be the primary focus of future research. The challenges to ensure that pregnant women are aware of and understand the guidelines, need to be addressed and all healthcare providers should actively encourage safe participation in PA during pregnancy.