, Volume 17, Issue 4, pp 521–529 | Cite as

Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations

  • Dimitra SavvakiEmail author
  • Eleftheria Taousani
  • Dimitrios G. Goulis
  • Efrosini Tsirou
  • Evangelia Voziki
  • Helen Douda
  • Nikolaos Nikolettos
  • Savvas P. Tokmakidis
Original Article



Τo summarize and present the main guidelines for exercise during normal pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM).


Relevant guidelines were retrieved through the electronic databases PubMed (MEDLINE), CENTRAL (Cochrane), and Embase; reference sections of the retrieved publications; proceedings of the main congresses in the field; and websites of relevant organizations published during the years 2000–2018.


All guidelines recommend aerobic training from 60 to 150 min/week, with an upper limit of 30 min/day. Exercise is safe, even on a daily basis. Resistance exercise is suggested by five national guidelines (Australia, Canada, Denmark, Norway, and the UK). Discrepancies exist regarding the recommended intensity of exercise. Canada, Japan, Spain, and the UK use both objective (heart rate and maximum oxygen consumption) and subjective criteria (Borg’s Scale and talk test) to determine the effectiveness and safety of exercise. Only Canada provides specific recommendations, according to the woman’s age and level of physical condition. Women with GDM on no insulin treatment do not need to take extra precautions during exercise. However, due to their condition of hyperglycemia, they must comply with the recommendation issued for type 2 diabetes. The prescription and supervision of exercise should be carried out in a similar way as for uncomplicated pregnancies. Finally, women with GDM on insulin treatment need to follow the same recommendations as for those for pregnant women with type 1 diabetes.


Health professionals must be informed about the correct planning and execution of physical exercise programs so as to safely achieve the maximum effectiveness of exercise-induced health-related benefits in pregnant women.


Pregnancy Guidelines Physical exercise Gestational diabetes mellitus 



American College of Obstetricians and Gynecologists


American College of Sport Medicine


American Diabetes Association


Adult Pre-Exercise Screening System


Body mass index


Beats per minute


Canadian Society for Exercise Physiology


Exercise and Sport Science Australia


Frequency (F), intensity (I), time (T), and type (T)


Gestation diabetes mellitus


Glucose transporter type 4


Heart rate reserve


Metabolic equivalent of task


Nutrition and Exercise Lifestyle Intervention Program


Physical Activity Readiness Medical Examination


Society of Obstetricians and Gynecologists of Canada


Maximum consumption of oxygen


Author contributions

D.S. wrote the first draft and edited the manuscript; E.Ta. wrote up the precautions required before initiation of an exercise program; D.G.G. (Endocrinology - Gestational diabetes), E.Ts. (Diet - Gestational diabetes), and S.T. (Clinical Ergophysiology and Exercise) made significant contributions in their areas of expertise and edited the first draft. E.V., H.D., and N.N. edited and revised the manuscript for the intellectual content.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

42000_2018_85_MOESM1_ESM.docx (25 kb)
ESM 1 (DOCX 24 kb)


  1. 1.
    Joy E, Mottola MF, Chambliss H (2013) Integrating exercise is medicine into the care of pregnant women. Curr Sports Med Rep 12:245–247CrossRefGoogle Scholar
  2. 2.
    Colberg SR, Sigal RJ, Yardly et al (2016) Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 39:2065–2079CrossRefGoogle Scholar
  3. 3.
    American Diabetes Association (2015) Management of diabetes in pregnancy. Diabetes Care 38:S77–S79CrossRefGoogle Scholar
  4. 4.
    Redman L (2006) Symposium: diet, nutrition and exercise in reproduction. Physical activity and its effects on reproduction. Reprod BioMed Online 12:579–586CrossRefGoogle Scholar
  5. 5.
    Norman RJ, Noakes M, Wu R, Davies MJ, Moran L, Wang JX (2004) Improving reproductive performance in overweight/obese women with effective weight management. Hum Reprod Update 10:267–280CrossRefGoogle Scholar
  6. 6.
    Blaize N, Pearson KJ, Newcomer SC (2015) Impact of maternal exercise during pregnancy on offspring chronic disease susceptibility. Exerc Health Child 43:198–203Google Scholar
  7. 7.
    Colberg SR, Castorino K, Jovanovič L (2013) Prescribing physical activity to prevent and manage gestational diabetes. World J Diabetes 4:256–262CrossRefGoogle Scholar
  8. 8.
    Dempsey JC, Sorensen TK, Williams MA, Lee IM, Miller RS, Dashow EE, Luthy DA (2004) Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Am J Epidemiol 159:663–670CrossRefGoogle Scholar
  9. 9.
    Downs SD, Hausenblas H (2004) Women’s exercise beliefs and behaviors during their pregnancy and postpartum. J Midwifery Women's Health 49:138–144CrossRefGoogle Scholar
  10. 10.
    U.S. Department of Health and Human Services, Physical Activity Guidelines Advisory Committee 2008 Physical Activity Guidelines Advisory Committee Report, Washington. DC. Accessed November 22, 2018
  11. 11.
    American College of Obstetricians and Gynecologists (2002) Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol 99(1):171–173Google Scholar
  12. 12.
    Clapp JF III (2008) Long-term outcome after exercising throughout pregnancy: fitness and cardiovascular risk. Am J Obstet Gynecol 199:489–495CrossRefGoogle Scholar
  13. 13.
    Bahls M, Sheldon RD, Taheripour P, Clifford KA, Foust KB, Breslin ED, Marchant-Forde JN, Cabot RA, Laughlin MH, Bidwell CA, Newcomer SC (2013) Mothers’ exercise during pregnancy programs vasomotor function in adult offspring. Exp Phys 99:205–219CrossRefGoogle Scholar
  14. 14.
    Αmerican College of Sports Medicine. Sports Medicine Bulletin (2009) ACSM’s guidelines for exercise testing and prescription, 8th edn. Lippincott Williams & Wilkins, Baltimore (MD)Google Scholar
  15. 15.
    Pre- and Post-Natal Exercise Guidelines Fitness Australia 2013 Health and Fitness Industry Association. [Accessed November 22, 2018].
  16. 16.
    Bauer PW, Broman CL, Pivarnik JM (2010) Exercise and pregnancy knowledge among healthcare providers. J Womens Health 19:335–341CrossRefGoogle Scholar
  17. 17.
    ACSM (2000) Guidelines for exercise testing and prescription, 6th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  18. 18.
    Savoulidi Κ (2009) Physical exercise and pregnancy: research in the context of the mother-child in Crete (REA study). School of Health Sciences, Faculty of Medicine. MSc thesis, Post-graduate program «Public Health and Management of Health Services» (in Greek)Google Scholar
  19. 19.
    U.S. Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans (2008) ODPHP Publication No. U0036. Washington. D.C. at [Accessed November 20, 2018]. Accessed November 1, 2012
  20. 20.
    Davies G, Wolfe L, Mottola M, MacKinnon C (2003) Joint SOGC/CSEP clinical practice guideline: exercise in pregnancy and the postpartum period. Can J Appl Physiol 28:330–341CrossRefGoogle Scholar
  21. 21.
    Krans EE, Gearhart JG, Dubbert PM (2005) Pregnant women’s beliefs and influences regarding exercise during pregnancy. J Miss State Med Assoc 46:67–73PubMedGoogle Scholar
  22. 22.
    Mudd L, Owe KM, Mottola MF, Pivarnik JM (2013) Health benefits of physical activity during pregnancy: an international perspective. Med Sci Sports Exerc 45:268–277CrossRefGoogle Scholar
  23. 23.
    Stromme S, Anderssen S, Hjermann I, Sundgot-Borgen J, Mæhlum S, Aadland A (2000) Physical activity and health – guidelines. The Directorate of Health and Social Affairs. [Accessed November 22, 2018].
  24. 24.
    Damm P, Klemmensen A, Clausen T et al (2008) Physical activity and pregnancy.,Sandbjerg. Accessed September 9, 2018
  25. 25.
    Royal College of Obstetricians and Gynaecologists 2006 Exercise in pregnancy. RCOG Statement No. 4. [Accessed November 22, 2018]. ExercisePregnancy2006.pdf
  26. 26.
    Haute Autorité de Santé (2005) How to better inform pregnant women? Recommendations of the HAS for health professionals. Gynecol Obstet Fertil 33(11):926–948CrossRefGoogle Scholar
  27. 27.
    Miyake H, Kawabata I, Nakai A (2010) The guideline for safety sports during pregnancy. J Jpn Clin Sports Med 18(2):216–218Google Scholar
  28. 28.
    Gurpegui M (20010 Ejercicio fisico y deporte durante el embarazo. In: Gonzalez E (ed) Manual de Asistencia al Embarazo Normal. Seccion de Medicina Perinatal de la Sociedad Española de Ginecologia y Obstetricia. 2:357–371Google Scholar
  29. 29.
    Denmark National Board of Health (2011) Physical activity - handbook on prevention and treatment. [Accessed November 22, 2018]. Haandbog.pdf
  30. 30.
    Zhang C, Solomon CG, Manson JE, Hu FB (2006) A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Int Med 166:543–548CrossRefGoogle Scholar
  31. 31.
    Hall DC, Kaufmann DA (1987) Effects of aerobic and strength conditioning on pregnancy outcomes. Am J Obstet Gynecol 157:1199–1203CrossRefGoogle Scholar
  32. 32.
    Sports Medicine Australia (2002) SMA statement: the benefits and risks of exercise during pregnancy. J Sci Med Sport 5:11–19Google Scholar
  33. 33.
    Borg G (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381PubMedGoogle Scholar
  34. 34.
    Davenport MH, Charlesworth S, Vanderspank D, Sopper MM, Mottola MF (2008) Development and validation of exercise target heart rate zones for overweight and obese pregnant women. Appl Physiol Nutr Metab 33:984–989CrossRefGoogle Scholar
  35. 35.
    Mottola MF, Davenport MH, Brun CR, Inglis SD, Charlesworth S, Sopper MM (2006) VO 2 peak prediction and exercise prescription for pregnant women. Med Sci Sports Exerc 38:1389–1395CrossRefGoogle Scholar
  36. 36.
    Artal R, O’Toole M (2003) Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med 37:6–12CrossRefGoogle Scholar
  37. 37.
    Pereira MA, Rifas-Shiman SL, Kleinman KP (2007) Predictors of change in physical activity during and after pregnancy: Project Viva. Am J Prev Med 32:312–319CrossRefGoogle Scholar
  38. 38.
    Wolfe L, Mottola M, 2002 Physical activity readiness medical examination for pregnancy: PARmed-X for pregnancy. Canadian Society of Exercise Physiology & Health Canada. [Accessed November 22, 2018].
  39. 39.
    Poulakos P, Mintziori G, Tsirou E et al (2015) Comments on gestational diabetes mellitus: from pathophysiology to clinical practice. Hormones (Athens) 14:335–344Google Scholar
  40. 40.
    Padayachee C, Coombes JS (2015) Exercise guidelines for gestational diabetes mellitus. World J Diabetes 6:1033–1044CrossRefGoogle Scholar
  41. 41.
    Ruchat SM, Mottola MF (2013) The important role of physical activity in the prevention and management of gestational diabetes mellitus. Diabetes Metab Res Rev 29:334–346CrossRefGoogle Scholar
  42. 42.
    American Diabetes Association (ADA) 2004 Gestational diabetes mellitus. Diabetes Care 27(Suppl 1):S88-90.Google Scholar
  43. 43.
    ACOG (2015) Committee Opinion No. 650: Physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol 126:e135–e142CrossRefGoogle Scholar
  44. 44.
    Artal R (2003) Exercise: the alternative therapeutic intervention for gestational diabetes. Clin Obstet Gynecol 46:479–487CrossRefGoogle Scholar
  45. 45.
    Hayman M, Brown W (2016) Sports Medicine Australia (SMA) Exercise in pregnancy and the postpartum period. Position Statement. [Accessed November 22, 2018].
  46. 46.
    Thomas DT, Erdman KA, Burke LM (2016) American College of Sports Medicine Joint Position Statement. Nutrition and athletic performance. Med Sci Sports Exerc 48:543–568PubMedGoogle Scholar
  47. 47.
    Artal R, Catanzaro RB, Gavard JA et al (2007) A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab 32:596–601CrossRefGoogle Scholar
  48. 48.
    Davenport MH, Mottola MF, McManus R (2008) A walking intervention improves capillary glucose control in women with gestational diabetes mellitus: a pilot study. Appl Physiol Nutr Metab 33:511–517CrossRefGoogle Scholar
  49. 49.
    Mottola M, Ruchat SM, 2011 Exercise Guidelines for Women with Gestational Diabetes. Gestational Diabetes Prof. Miroslav Radenkovic (Ed), ISBN: 978-307-581-5 In tech, Available from: [Accessed November 22, 2018].
  50. 50.
    Sopper MM, Hammond JMS, Giroux I, McManus R, Mottola MF (2004) Genesis of NELIP: a Nutrition, Exercise and Lifestyle Intervention Program to help prevent excess weight gain and gestational diabetes mellitus in high-risk women. Can J Diabetes 28:296Google Scholar
  51. 51.
    Mottola MF, Sopper MM, Vanderspank D (2005b) Insulin sensitivity is maintained in late pregnancy among overweight women at risk for gestational diabetes, participating in a Nutrition and Exercise Lifestyle Intervention Program (NELIP). Proceedings of the 48th Annual Meeting of the Canadian Federation of Biological Societies, 62Google Scholar
  52. 52.
    Mottola MF, Lander S, Giroux I, Hammond JMS, Lebrun C, McManus R, Sopper MM (2005a) Glucose and insulin responses in women at risk for gestational diabetes mellitus before and after a Nutrition and Exercise Lifestyle Intervention Program (NELIP). Med Sci Sports Exerc 37:S309–S310CrossRefGoogle Scholar
  53. 53.
    Zaharieva DP, Riddell MC (2015) Prevention of exercise-associated dysglycemia: a case study-based approach. Diabetes Spectr 28:55–62CrossRefGoogle Scholar
  54. 54.
    Wolfe L, Mottola M (2002) Physical activity readiness medical examination for pregnancy: PARmed-X for pregnancy. Canadian Society of Exercise Physiology & Health Canada. Accessed December 3, 2012

Copyright information

© Hellenic Endocrine Society 2018

Authors and Affiliations

  • Dimitra Savvaki
    • 1
    • 2
    Email author
  • Eleftheria Taousani
    • 2
    • 3
  • Dimitrios G. Goulis
    • 2
  • Efrosini Tsirou
    • 2
  • Evangelia Voziki
    • 2
  • Helen Douda
    • 1
  • Nikolaos Nikolettos
    • 4
  • Savvas P. Tokmakidis
    • 1
  1. 1.School of Physical Education and Sports ScienceDemocritus University of ThraceKomotiniGreece
  2. 2.Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical SchoolAristotle University of ThessalonikiThessalonikiGreece
  3. 3.Department of MidwiferyAlexander Technological Educational Institute of ThessalonikiThessalonikiGreece
  4. 4.Physiology Laboratory, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece

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