1 of 10 Davenport MH, et al. Br J Sports Med 2019;53:90–98. doi:10.1136/bjsports-2018-099400 Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis Margie H Davenport, 1 Andree-Anne Marchand, 2 Michelle F Mottola, 3 Veronica J Poitras, 4 Casey E Gray, 5 Alejandra Jaramillo Garcia, 4 Nick Barrowman, 6 Frances Sobierajski, 1 Marina James, 1 Victoria L Meah, 7 Rachel J Skow, 1 Laurel Riske, 1 Megan Nuspl, 8 Taniya S Nagpal, 3 Anne Courbalay, 2 Linda G Slater, 9 Kristi B Adamo, 10 Gregory A Davies, 11 Ruben Barakat, 12 Stephanie-May Ruchat 13 Review To cite: Davenport MH, Marchand A-A, Mottola MF, et al. Br J Sports Med 2019;53:90–98. ► Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ bjsports-2018-099400). For numbered affliations see end of article. 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@ualberta.ca Accepted 24 July 2018 Published Online First 18 October 2018 © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. 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 identifed 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 fndings 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. INTRODUCTION Approximately 50% of women experience low back (LBP) or pelvic girdle (PGP) pain during preg- nancy; 25% continue to experience pain 1 year after delivery. A 10 year follow-up study reported that 1 in 10 women with PGP in pregnancy has severe consequences up to 11 years postpartum. 1–5 LBP is pain or discomfort located between the 12th rib and the gluteal fold, and PGP has been defined as ‘pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joints’. 6 Despite the fact that both conditions are considered distinct entities, the concomitance of LBP and PGP, herein referred to as lumbopelvic pain (LBPP), puts a greater burden on pregnant women regarding health quality and daily functioning. 7 With repercussions such as disruption of sleep, social and sexual life, work capacity and increased psychological stress, 8 9 it is not surprising that pregnant women experiencing PGP have also been reported to be less likely to exercise regularly during pregnancy. 10 In the general population, ‘moderate’ quality evidence suggests exercise has a small positive effect on the severity of LBP compared with usual care, which is comparable with the effectiveness of other non-pharmacological approaches recom- mended for the management of acute or chronic LBP. 11 However, compared with other cost effective non-pharmacological treatments, such as interdisci- plinary rehabilitation, acupuncture, spinal manip- ulation or cognitive behavioural therapy, exercise is easily accessible as part of a self-management strategy, can require minimal equipment and can be What is already known? ► Approximately 50% of women experience low back or pelvic girdle pain during pregnancy; 25% continue to experience pain 1 year after delivery. ► Pelvic girdle pain is associated with a decrease in regular physical activity during pregnancy. What are the new fndings? ► Being physically active during pregnancy did not reduce the odds of developing low back, pelvic or lumbopelvic pain either during pregnancy or in the postpartum period. ► Physical activity performed in various formats during pregnancy decreased the severity of low back, pelvic and lumbopelvic pain during pregnancy and the early postpartum period. on May 29, 2020 by guest. Protected by copyright. http://bjsm.bmj.com/ Br J Sports Med: first published as 10.1136/bjsports-2018-099400 on 18 October 2018. Downloaded from