In our study, we identified two questions:

The review was conducted according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) (23) in February 2024. The study protocol was registered on Open Science Framework (registration number: 10.17605/OSF.IO/3QFR9). Figure 1 shows the PRISMA diagram of the article screening process (24). Studies from January 2020 to February 2024 were considered for inclusion based on inclusion/exclusion criteria (Table 1). The review included officially recognized guidelines for PA during pregnancy, targeted at healthy pregnant women, published in English (or with available translations) on or after the publication of the 2020 WHO guidelines. The guidelines needed to focus on general PA or structured exercise programs (recommendations for PA type, intensity, duration, and frequency). We excluded non-guideline documents, guidelines for pregnant women with specific health conditions (unless addressed within broader guidelines), pre-2020 guidelines (unless significantly updated), and non-English guidelines without translations.

A systematic search for guidelines and recommendations on PA during pregnancy was conducted in February 2024. PubMed, ScienceDirect, and Web of Science databases were searched. Search string: “(“pregnancy” AND (“physical activity” OR “exercise”)) AND (“recommendations” OR “guidelines”) AND (“public health” OR “sports medicine organization”).” Guidelines issued by national representative bodies, which do not necessarily constitute peer-reviewed research publications, were collected in a secondary search of publicly available online resources using the previously described search string. The documents could have been published in 2020 (the year of publication the recent WHO guidelines) and later. The search omitted non-peer-reviewed documents.

From the search results, duplicates were removed. Two authors screened study titles using the inclusion/exclusion criteria (Table 1). Studies with titles implying eligibility for inclusion had the abstract screened. If the abstract indicated the study may be eligible for inclusion, then the full text was downloaded for review. The references of papers were analyzed to identify additional papers fulfilling the inclusion criteria that may have been missed by the search strategy. The full texts were procured and independently reviewed and analyzed by two investigators (AW and JC) using inclusion/exclusion criteria. In the event of a split opinion as to whether a particular document should be qualified for examination, a third investigator (JM) was ready to make the final decision.

10 papers were selected for data charting (25–34). The data from selected articles were extracted independently in a Microsoft Excel sheet by three investigators (AW, AS, JC) and put into a form designed after deliberations by all the authors (Table 2). The following data were charted: authors or publishing organizations, country, year of publication, and title. Next we extracted information related to PA during pregnancy based on FITT principle: recommended type of PA (divided into two subsections: recommendation and explanation/examples), intensity of PA (divided into two subsections: recommendation and explanation/examples), methods of monitoring the PA intensity (divided into two subsections: recommendation and explanation/examples), recommended time/duration of PA, recommended frequency of PA, information on what is not recommended in relation to PA during pregnancy, other information in relation to PA, consistency of the information included. In the category “other information in relation to PA” we treated information related to warning signs, contraindications, bed rest, elite athletes, and environment (high altitude, high temperature, humidity, etc.). In the following text, we use the term “PA information categories” to refer to information obtained based on the extraction criteria mentioned above.

A systematic search of public health and sports medicine organizations` guidelines for pregnancy identified a total of 619 papers for evaluation. After further exclusion (the rejection criteria are included in Table 1) and removing duplicates and papers irrelevant to the selected topic, 6 papers were selected for data charting (25, 29, 31–34). Based on the reference lists presented in these papers, an additional 4 studies were included (26–28, 30). Two recommendations were published in Australia, one each in Australia and New Zealand, Austria, Brazil, Poland, the United Kingdom, and the United States, and two by International Organizations.

Ten documents containing recommendations on PA during pregnancy from eight countries were analyzed: Australia, Australia & New Zealand, Austria, Brazil, Poland, the United Kingdom, the United States, and two international organizations: European Board and College of Obstetrics and Gynecology (EBCOG) and World Health Organization (WHO) looking for information on recommendations related to PA core components and other additional information’s related to them (Table 2).

Based on the information provided, there are no explicit divergences in results evident from the analyzed documents regarding PA recommendations during pregnancy. The recommendations appear to be largely congruent, particularly emphasizing moderate-intensity PA, individualization based on the woman’s health and fitness level, and consultation with healthcare providers for those with any contraindications or pre-existing conditions. This aligns closely with the findings presented by Hayman et al. (35) in their scoping review, which highlights that guidelines from multiple countries recommend 150–300 min per week of moderate-intensity aerobic activity for women with uncomplicated pregnancies, alongside pelvic floor and muscle-strengthening exercises. Moreover, the authors underscores the global agreement on the necessity of adapting PA recommendations to individual circumstances.

Importantly, the recommendations provided by various health and sports medicine organizations are often detailed enough to help plan a safe and effective exercise session for pregnant women. Guidelines like those from the American College of Obstetricians and Gynecologists (25), Australian Government. Department of Health (AGDH) (30), British Association of Sport and Exercise Medicine (27), Department of Ergometry, Exercise, Nuclear Cardiology, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology (31), Polish Society of Gynecologists and Obstetricians (PTGiP) and Polish Society of Sports Medicine (PTMS) (33), and Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) (34) typically offer clear instructions on the types and intensity of exercise that are considered safe and beneficial during pregnancy. It seems very important that all countries can offer such guidelines in their national languages to promote PA during pregnancy worldwide.

Regular PA confers numerous health benefits for pregnant women, aligning with the 2020 World Health Organization’s guideline (29) emphasizing the importance of aerobic and muscle-strengthening activities during pregnancy. However, a crucial distinction exists between general physical activity and structured exercise programs, which influences the practical application of these recommendations. The WHO guideline (29), while advocating for at least 150 min of moderate-intensity aerobic activity per week, predominantly focus on promoting overall PA, encompassing any bodily movement like walking, housework, or occupational tasks. In contrast, structured exercise programs involve planned, repetitive, and purposeful PA with specific goals for improving or maintaining physical fitness (27) such as swimming, prenatal yoga, or supervised strength training (20).

This distinction is essential because pregnant women and healthcare providers often seek guidance on structured exercise programs rather than simply increasing general PA. While the WHO guideline (29) offer valuable public health advice, it lacks the specific exercise prescriptions needed to address the nuances of adapting exercise routines throughout pregnancy, including type, intensity, frequency, and duration. This gap is addressed by various national and professional bodies, such as those in Australia (30), Brazil (31), Poland (33), and New Zealand (34), which provide more detailed recommendations, often tailored to specific populations and circumstances. That guideline, while valuable for its practical advice, frequently lack the rigorous peer-review process of scientific publications, highlighting the need for further research to validate and refine these recommendations, especially in the context of high-intensity interval training and exercise at altitude. The analyzed documents lack detailed information on how to encourage women to engage in regular PA during pregnancy. It is evident that despite the known benefits of PA during pregnancy, a significant proportion of pregnant women do not meet the recommended guidelines (36). Studies have shown that pregnant women often reduce their PA levels during pregnancy, indicating a gap between expert recommendations and actual behavior (37). Furthermore, the lack of motivation, fear of potential fetal harm, and individual attitudes and practice habits of healthcare providers can influence the engagement of pregnant women in PA (38). Healthcare providers are often the primary source of PA information for pregnant women. Okafor and Goon (39) highlighted that effective counselling from healthcare professionals is associated with increased uptake of PA by African pregnant women. They found that women who received specific advice or counselling about PA were more likely to engage in and maintain regular PA. This aligns with findings from Sparks et al., who noted that adapted PA prescriptions from healthcare providers could enhance adherence to recommended guidelines (40).

Some contradictions between public health and sports medicine PA guidelines for pregnant women can stem from different objectives and interpretations of scientific evidence. Public health guidelines, such as those issued by the American College of Obstetricians and Gynecologists (25) typically emphasize the safety and well-being of the general population of pregnant women. They often recommend at least 150 min per week of moderate-intensity aerobic activity for healthy pregnant women, unless there are medical or obstetric complications. On the other hand, sports medicine organizations might provide more nuanced guidance for specific populations, such as athletes, and may support more vigorous exercise regimens as long as they are carefully monitored and deemed safe. Collaboration between different organizations, supported by scientific research and the practice of exercise specialists and trainers, would be advisable so that the newly developed guidelines have a broad context and are easily applicable by pregnant women with different needs.

While moderate-intensity PA is generally recommended for health benefits, some studies suggest that higher intensity activities may be necessary to achieve certain health benefits. There are studies suggesting that moderate-intensity PA may not always be sufficient to achieve certain benefits, and that higher intensity activities may be needed to obtain specific health advantages. For instance, highlighted that while studies show that moderate-intensity exercise is effective in reducing the risk of coronary heart disease, some studies suggest that only heavy or vigorous activity confers benefits (41). This implies that moderate-intensity exercise alone may not provide the same level of benefit as more intense PA. Moreover, Powell’s review (42) concluded that vigorous activity may offer greater cardioprotective benefits than moderate-intensity activity comparing the cardioprotective benefits of vigorous and moderate-intensity aerobic activity. This suggests that higher intensity exercise may be more effective in certain health outcomes compared to moderate-intensity exercise alone. Additionally, Janssen and Ross found that vigorous-intensity PA is related to metabolic syndrome independent of the PA dose, indicating that the intensity of PA plays a significant role in health outcomes (43).

What’s interesting, there are more and more studies supporting the safety and maternal and foetal health benefits of engaging in high-intensity PA during pregnancy. Hinman (44) found that moderate-and high-intensity exercise in normal pregnancies is safe for the developing fetus and has several important benefits.

High-intensity interval training (HIIT) during pregnancy has gained attention as an effective and time-efficient exercise modality (44). Wowdzia et al. proved that a single HIIT session was well tolerated by both the mother and the foetus in terms of both metabolic (45) and cardiorespiratory parameters (46). While the specific effects of long-term HIIT during pregnancy are still being explored, preliminary studies suggest that HIIT can be a suitable exercise option for pregnant women, offering benefits such as improved respiratory and cardiovascular adjustments, enhanced exercise performance, and body composition (47). Additionally, 8-week HIIT programme during pregnancy has been shown to be an effective intervention in improving mothers’ mental health and preventing depression (48, 49). Szumilewicz et al. (50) mentioned that while HIIT is popular among women in general, there’s limited data on its safety and effectiveness during pregnancy. What’s more, the authors highlighted that conservative guidelines from the past discouraged strenuous exercise during pregnancy, but more recent research suggested a need for updated recommendations. They also pointed out that some pregnant women might be interested in continuing HIIT or seeking information online, emphasizing the importance of developing and disseminating reliable guidelines on this topic. Interestingly, only Polish guidelines have so far initiated a discussion on HIIT in pregnancy (33). It should be noted that EBCOG has been quite cautious about high-intensity PA, noting the potential risks (32). Nevertheless, the topic of high-intensity PA in pregnancy should certainly be considered a visible trend, both in scientific research and in the context of planning training programs for the pregnant population.

While exercising at high altitudes during pregnancy can stimulate beneficial physiological adaptations like increased hemoglobin concentrations and improved cardiovascular function, caution is advised due to potential risks. Keyes et al. (51) found that babies born to women who resided at high altitude during pregnancy were more likely to have intrauterine growth retardation (IUGR), need oxygen at birth, and be admitted to the NICU than lowland residents with or without altitude travel during pregnancy. However, in the same study the authors concluded that women who are active in outdoor sports and travel to high altitude have a low rate of complications. Umar et al. (52) observed that pregnant women living at higher altitudes often exhibit increased hemoglobin, enhancing oxygen transport to both mother and fetus, potentially mitigating risks like intrauterine growth restriction. Additionally, regular PA at altitude may improve maternal health outcomes, including reduced incidences of gestational diabetes and hypertensive disorders (51). However, high-altitude environments, particularly above 2,500 meters, can pose risks such as altitude sickness, adversely affecting both maternal and fetal health (51).

Care must be taken in making recommendations regarding exercising at altitude during pregnancy since there is so little supporting evidence and research in this topic (52).” There is no data on the safety of altitude training for competitive female athletes. Therefore, pregnant women should engage in altitude exercise cautiously, ensuring acclimatization and monitoring for signs of distress. They should consult healthcare providers to adapt exercise regimens that ensure safety and optimize health outcomes.

Even though efforts were made to include all illegible recommendations in the review, some relevant documents may have been overlooked. Moreover, documents reported in languages other than English or issued by institutions other than government, medical, or sports institutions were excluded.

Because available recommendations regarding exercise during pregnancy not always have the character of scientific work and more often constitute an official representative position of institution, it was in some cases impossible to find them in scientific databases. Nevertheless, the authors tried to adopt such a procedure for searching for material for analysis that would make it effective and repeatable, while being aware that some documents that met the criteria for inclusion in the analysis could have been omitted.