REF-1710 · Xiang et al., 2026 · International Journal of Nursing Studies, · Paper · PubMed

Exercise programmes in pregnancy raised activity and lowered several complications: a meta-analysis of 88 randomised trials (most at some concerns for bias) found more total activity (SMD 0.62, 95% CI 0.30-0.94), less gestational diabetes (RR 0.75, 0.63-0.88), fewer hypertensive disorders (RR 0.67, 0.54-0.83), fewer caesarean sections (RR 0.86, 0.80-0.93) and less gestational weight gain (SMD −0.28, −0.36 to −0.19), with no significant effect on sedentary time, prenatal depression, birthweight or preterm birth

Main caveat: The authors': subgroup analyses of intervention features are exploratory; little or no effect on sedentary behaviour, depression, birthweight or preterm birth.
fairly strong evidenceMeasured on non-athletes and recreational peopleRead from the abstract only

Xiang and colleagues asked whether exercise interventions in pregnancy raise physical activity, which features of the interventions go with larger effects, and what they do to sedentary behaviour, maternal health and pregnancy outcomes.

They searched eight databases to 1 April 2026, included 88 randomised trials, judged most of them at some concerns for bias with RoB 2.0, and pooled with random-effects models. Exercise interventions increased total physical activity (SMD 0.62), moderate-to-vigorous activity (0.32), exercise activity (1.04) and step count (0.33).

They reduced gestational diabetes (RR 0.75), hypertensive disorders of pregnancy (RR 0.67), caesarean section (RR 0.86), total gestational weight gain (SMD −0.28), fasting glucose (SMD −0.67) and 2-hour post-meal glucose (SMD −0.48). They had no significant effect on sedentary behaviour, prenatal depression, birthweight or preterm birth.

Exploratory subgroups suggested larger activity effects with combined aerobic and strength training, individualised or unsupervised formats and mobile-health support. The authors conclude that exercise interventions appear to increase activity in pregnancy and may improve maternal health and pregnancy outcomes.

Participants

88 RCTs of pregnant women; the number of women, their risk status, age, BMI and baseline activity are not in the abstract.

Protocol

Search: eight databases (not named in the abstract), inception to 1 April 2026; PROSPERO CRD420251231458.
Inclusion: randomised controlled trials of exercise interventions in pregnancy.
Appraisal: Cochrane Risk of Bias 2.0; most trials rated as having some concerns.
Analysis: RevMan 5.4, random effects; SMD for continuous and RR for dichotomous outcomes; exploratory subgroups by theoretical basis, exercise type, delivery format and population characteristics.
Not in the abstract: comparators, exercise doses and timing, heterogeneity, certainty (GRADE), trials and women per outcome, funding.

Key Results

Outcome (exercise vs control)Effect (95% CI)
Total physical activitySMD 0.62 (0.30 to 0.94)
Moderate-to-vigorous physical activitySMD 0.32 (0.08 to 0.57)
Exercise activitySMD 1.04 (0.63 to 1.46)
Step countSMD 0.33 (0.12 to 0.55)
Gestational diabetesRR 0.75 (0.63 to 0.88)
Hypertensive disorders of pregnancyRR 0.67 (0.54 to 0.83)
Caesarean sectionRR 0.86 (0.80 to 0.93)
Total gestational weight gainSMD −0.28 (−0.36 to −0.19)
Fasting blood glucoseSMD −0.67 (−1.01 to −0.34)
2-hour postprandial blood glucoseSMD −0.48 (−0.65 to −0.30)
Sedentary behaviour, prenatal depression, birthweight, preterm birthno significant effect (estimates not in the abstract)
Exploratory subgroups (activity outcomes): effects differed by theoretical underpinning, exercise type, delivery format and population; programmes mixing aerobic with strength work, delivered individually or without supervision, or backed by mobile-health tools went with larger effects (no figures in the abstract).

Practical Application

Exercise in pregnancy goes with fewer complications, not more. Across 88 trials, exercise programmes lowered the risk of gestational diabetes by a quarter (RR 0.75), hypertensive disorders by a third (RR 0.67) and caesarean section (RR 0.86), and reduced weight gain, with no significant effect on birthweight or preterm birth (estimates not in the abstract, so "no significant effect" here is not proof of none).
Consistent with [SYNTH-95]'s default: once the obstetric team has cleared her, a woman keeps training, aerobic and strength (REF-567, REF-568). This review adds trial-level benefits in women who were mostly not athletes; it says nothing about vigorous or athlete-level training, which the guide takes from REF-1396 and REF-1395, and it changes no line of the guide.
Inference, not tested here: for an athlete, keeping some strength work alongside aerobic training fits the combined-training subgroup and the guide's default; the dose and intensity for a trained woman are not set by this review.
Not treatment advice: whether and how to exercise in a given pregnancy, and anything about diabetes, blood pressure or the baby's growth, is decided by the obstetric provider; warning signs stop the session and go to them (SYNTH-95).

Limitations

The authors': subgroup analyses of intervention features are exploratory; little or no effect on sedentary behaviour, depression, birthweight or preterm birth.
Not in the abstract: heterogeneity, certainty grading, trials and women per outcome, comparators, exercise doses, the women's risk status, funding.
Risk of bias: most trials at some concerns; the split by domain is not in the abstract (exercise trials usually cannot blind participants: our reading).
Outcomes: how activity was measured (self-report or device) is not in the abstract; fasting and post-meal glucose are markers.
Written from the abstract and the PubMed record; full text not read.
How this entry was checked and changed
Why this level

a meta-analysis of randomised trials whose abstract reports its risk-of-bias appraisal and the result (most trials at some concerns, not mostly high risk), so the abstract-only cap does not apply; held at A- because heterogeneity, certainty grading and the number of trials per outcome are not in the abstract, how activity was measured is not stated, and the intervention-feature findings are exploratory subgroup splits; the glucose results are markers and stand one step lower (B+)