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Review
Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis
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  1. Margie H Davenport1,
  2. Andree-Anne Marchand2,
  3. Michelle F Mottola3,
  4. Veronica J Poitras4,
  5. Casey E Gray5,
  6. Alejandra Jaramillo Garcia4,
  7. Nick Barrowman6,
  8. Frances Sobierajski1,
  9. Marina James1,
  10. Victoria L Meah7,
  11. Rachel J Skow1,
  12. Laurel Riske1,
  13. Megan Nuspl8,
  14. Taniya S Nagpal3,
  15. Anne Courbalay2,
  16. Linda G Slater9,
  17. Kristi B Adamo10,
  18. Gregory A Davies11,
  19. Ruben Barakat12,
  20. Stephanie-May Ruchat13
  1. 1 Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Kinesiology, Sport and Recreation, Women and Children’s Health Research Institute, Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Department of Anatomy, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
  3. 3 R Samuel McLaughlin Foundation-Exercise and Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Children’s Health Research Institute, The University of Western Ontario, London, Ontario, Canada
  4. 4 Independent Researcher, Ottawa, Ontario, Canada
  5. 5 Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  6. 6 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  7. 7 Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
  8. 8 Faculty of Medicine and Dentistry, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
  9. 9 John W Scott Health Sciences Library, University of Alberta, Edmonton, Alberta, Canada
  10. 10 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
  11. 11 Department of Obstetrics and Gynaecology, Queen’s University, Kingston, Ontario, Canada
  12. 12 Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
  13. 13 Department of Human Kinetics, Universite du Quebec a Trois-Rivieres, Trois-Rivieres, Quebec, Canada
  1. Correspondence to Dr Margie H Davenport, Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton T6G 2E1, Canada; mdavenpo{at}ualberta.ca

Abstract

Objective The purpose of this review was to investigate the relationship between prenatal exercise, and low back (LBP), pelvic girdle (PGP) and lumbopelvic (LBPP) pain.

Design Systematic review with random effects meta-analysis and meta-regression.

Data sources Online databases were searched up to 6 January 2017.

Study eligibility criteria Studies of all designs were eligible (except case studies and reviews) if they were published in English, Spanish or French, and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (prevalence and symptom severity of LBP, PGP and LBPP).

Results The analyses included data from 32 studies (n=52 297 pregnant women). ‘Very low’ to ‘moderate’ quality evidence from 13 randomised controlled trials (RCTs) showed prenatal exercise did not reduce the odds of suffering from LBP, PGP and LBPP either in pregnancy or the postpartum period. However, ‘very low’ to ‘moderate’ quality evidence from 15 RCTs identified lower pain severity during pregnancy and the early postpartum period in women who exercised during pregnancy (standardised mean difference −1.03, 95% CI −1.58, –0.48) compared with those who did not exercise. These findings were supported by ‘very low’ quality evidence from other study designs.

Conclusion Compared with not exercising, prenatal exercise decreased the severity of LBP, PGP or LBPP during and following pregnancy but did not decrease the odds of any of these conditions at any time point.

  • pregnancy
  • exercise
  • back
  • pelvis

https://doi.org/10.1136/bjsports-2018-099400

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    Footnotes

    • Contributors MHD, S-MR, MFM, GAD and KBA contributed to the conception of the study. MHD, S-MR, MFM, GAD, KBA, AJG, NB, VJP, CEG, LGS and RB contributed to the design of the study and development of the search strategy. LGS conducted the systematic search. FS, MJ, VLM, RS, LR, MN, TSN, A-AM and AC completed the acquisition of the data. MHD, NB, S-MR and A-AM performed the data analysis. All authors assisted with the interpretation. A-AM, S-MR and MHD were the principal writers of the manuscript. All authors contributed to the drafting and revision of the final article. All authors approved the final submitted version of the manuscript.

    • Funding This project was funded by a Canadian Institute of Health Research Knowledge Synthesis Grant. MHD is funded by an Advancing Women’s Heart Health Initiative New Investigator Award supported by Health Canada and the Heart and Stroke Foundation of Canada. A-AM is funded by a Fonds de Recherche du Québec–Santé Doctoral Research Award. RS is funded by a Canadian Institutes for Health Research Doctoral Research Award.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.