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Editor’s comment: Prof. Dan Farine: Exercise in Pregnancy the Norwegian outlook
The issue of exercise in pregnancy has been studied extensively in the last 30 years with some researchers such as James Clapp the 3rd and Raoul Artal devoting a large portion of their careers to this issue. The data generated by them and others showed generally that exercise in pregnancy had a variety of positive effects on associated diseases (diabetes hypertension etc.) and specific pregnancy outcomes. Concerns that extensive physical activity would lead to poor outcomes were shown to be non-true in studies such as James Clapp’s who found that Olympians had better outcomes than sedentary pregnant women.
This Norwegian study is the largest so far on exercise and pregnancy and its size make the results more persuasive than previous smaller studies. The results are interesting in lots of different ways. It showed in general that being active may be more important than the type of activity chosen – this empowers women to choose an exercise regime and type that suites their preferred activities. It also showed that increased activity leads to reduced CS in primipara and that the effect was dose related which support a cause and effect – these results allow women to be more active if they wish to do so but be reassured that moderate or even mild exercise still confers significant benefit. It may be more interesting for women to realize that exercise at 17 weeks and 30 weeks were both linked to reduced Cesarean delivery rate – I am not sure if the conclusion “better later than never” is necessarily correct but the data does not show it is incorrect. The frequency of sedentary life style was highest among the younger women. This group of women have usually the lower CS rate. However, the data suggest that “the effect of age” could be overcome by hard (or even not that hard) work.
Like all studies this one has its own limitations, the important one is that exercise is often only one part of life style and the effect could be attributed to a ”package deal” and not to exercise per se. The other major one is that by the nature and design of the study the mechanism for these improvements could not be studied. This leads the way to future studies possibly using similar methodologies. Regardless, this study carries several very positive messages to pregnant women and their care givers.