All Americans should be physically active to improve overall health and fitness and to prevent many adverse health outcomes. Most Americans should follow the Guidelines of the child and adolescent, adult, or older adult chapters, depending upon their age. However, some people have conditions that raise special issues about recommended types and amounts of physical activity. This chapter provides guidance on physical activity for healthy women who are pregnant and for people with disabilities. This chapter also affirms and illustrates how physical activity is generally appropriate for adults with chronic conditions by considering three groups of adults:

• Adults with osteoarthritis;
• Adults with type 2 diabetes; and
• Adults who are cancer survivors.

Physical Activity for Women During Pregnancy and the Postpartum Period

Physical activity during pregnancy benefits a woman’s overall health. For example, moderate-intensity physical activity by healthy women during pregnancy maintains or increases cardiorespiratory fitness.

Strong scientific evidence shows that the risks of moderate-intensity activity done by healthy women during pregnancy are very low, and do not increase risk of low birth weight, preterm delivery, or early pregnancy loss. Some evidence suggests that physical activity reduces the risk of pregnancy complications, such as preeclampsia and gestational diabetes, and reduces the length of labor, but this evidence is not conclusive.

During a normal postpartum period, regular physical activity continues to benefit a woman’s overall health. Studies show that moderate-intensity physical activity during the period following the birth of a child increases a woman’s cardiorespiratory fitness and improves her mood. Such activity does not appear to have adverse effects on breast milk volume, breast milk composition, or infant growth.

Physical activity also helps women achieve and maintain a healthy weight during the postpartum period, and when combined with caloric restriction, helps promote weight loss.

Explaining the Guidelines

Women who are pregnant should be under the care of a health-care provider with whom they can discuss how to adjust amounts of physical activity during pregnancy and the postpartum period. Unless a woman has medical reasons to avoid physical activity during pregnancy, she can begin or continue moderate-intensity aerobic physical activity during her pregnancy and after the baby is born.

When beginning physical activity during pregnancy, women should increase the amount gradually over time. The effects of vigorous-intensity aerobic activity during pregnancy have not been studied carefully, so there is no basis for recommending that women should begin vigorous-intensity activity during pregnancy.

Women who habitually do vigorous-intensity activity or high amounts of activity or strength training should continue to be physically active during pregnancy and after giving birth. They generally do not need to drastically reduce their activity levels, provided that they remain healthy and discuss with their health-care provider how to adjust activity levels during this time.

During pregnancy, women should avoid doing exercises involving lying on their back after the first trimester of pregnancy. They should also avoid doing activities that increase the risk of falling or abdominal trauma, including contact or collision sports, such as horseback riding, downhill skiing, soccer, and basketball.

Physical Activity for People With Disabilities

The benefits of physical activity for people with disabilities have been studied in diverse groups. These groups include stroke victims, people with spinal cord injury, multiple sclerosis, Parkinson’s disease, muscular dystrophy, cerebral palsy, traumatic brain injury, limb amputations, mental illness, intellectual disability, and dementia.

Overall, the evidence shows that regular physical activity provides important health benefits for people with disabilities. The benefits include improved cardiovascular and muscle fitness, improved mental health, and better ability to do tasks of daily life. Sufficient evidence now exists to recommend that adults with disabilities should get regular physical activity. Physical activity in children and adolescents with disabilities is considered in Chapter 3—Active Children and Adolescents.

Explaining the Guidelines

In consultation with their health-care providers, people with disabilities should understand how their disabilities affect their ability to do physical activity. Some may be capable of doing medium to high amounts of physical activity, and they should essentially follow the Guidelines for adults.

Some people with disabilities are not able to follow the Guidelines for adults. These people should adapt their physical activity program to match their abilities, in consultation with their health-care providers. Studies show that physical activity can be done safely when the program is matched to an individual’s abilities.

Meeting the Guidelines

People with disabilities are encouraged to get advice from professionals with experience in physical activity and disability because matching activity to abilities can require modifying physical activity in many different ways. Some people with disabilities also need help with their exercise program. For example, some people may need supervision when performing muscle-strengthening activities, such as lifting weights.

Physical Activity for People With Chronic Medical Conditions

Adults with chronic conditions should engage in regular physical activity because it can help promote their quality of life and reduce the risk of developing new conditions. The type and amount of physical activity should be determined by a person’s abilities and the severity of the chronic condition. Three examples are provided below to illustrate the benefits of physical activity for persons with chronic conditions.

For many chronic conditions, physical activity provides therapeutic benefits and is part of recommended treatment for the condition. However, this chapter does not discuss therapeutic exercise or rehabilitation.

Example 1. Physical Activity for Adults With Osteoarthritis

Osteoarthritis is a common condition in older adults, and people can live many years with osteoarthritis. People with osteoarthritis are commonly concerned that physical activity can make their condition worse.

Osteoarthritis can be painful and cause fatigue, making it hard to begin or maintain regular physical activity. Yet people with this condition should get regular physical activity to lower their risk of getting other chronic diseases, such as heart disease or type 2 diabetes, and to help maintain a healthy body weight.

Strong scientific evidence indicates that both aerobic activity and muscle-strengthening activity provide therapeutic benefits for persons with osteoarthritis. When done safely, physical activity does not make the disease or the pain worse. Studies show that adults with osteoarthritis can expect improvements in pain, physical function, quality of life, and mental health with regular physical activity.

People with osteoarthritis should match the type and amount of physical activity to their abilities and the severity of their condition. Most people can usually do moderate-intensity activity for 150 minutes (2 hours and 30 minutes) a week or more, and may choose to be active 3 to 5 days a week for 30 to 60 minutes per episode. Some people with arthritis can safely do more than 150 minutes of moderate-intensity activity each week and may be able to tolerate equivalent amounts of vigorous-intensity activity. Health-care providers typically counsel people with osteoarthritis to do activities that are low impact, not painful, and have low risk of joint injury. Swimming, walking, and strength-training are good examples of this type of activity.

Example 2. Physical Activity for Adults With Type 2 Diabetes

Physical activity in adults with type 2 diabetes shows how important it can be for people with a chronic disease to be active. Physical activity has important therapeutic effects in people with diabetes, but it is also routinely recommended to reduce risk of other diseases and help promote a healthy body weight.

For example, strong scientific evidence shows that physical activity protects against heart disease in people with diabetes. Moderate-intensity activity for about 150 minutes a week helps to substantially lower the risk of heart disease. A person who moves toward 300 minutes (5 hours) or more of moderate-intensity activity a week gets even greater benefit.

Adults with chronic conditions should work with their health-care providers to adapt physical activity so that it is appropriate for their condition. For example, people with diabetes must be careful to monitor their blood glucose and avoid injury to their feet.

Example 3. Physical Activity for Cancer Survivors

With modern treatments, many people with cancer can either be cured or survive for many years, living long enough to be at risk of other chronic conditions, such as high blood pressure or type 2 diabetes. Some cancer survivors are at risk of recurrence of the original cancer. Some have experienced side effects of the cancer treatment.

Like other adults, cancer survivors should engage in regular physical activity for its preventive benefits. Physical activity in cancer survivors can reduce risk of new chronic diseases. Further, studies suggest physically active adults with breast or colon cancer are less like to die prematurely or have a recurrence of the cancer. Physical activity may also play a role in reducing adverse effects of cancer treatment.

Cancer survivors, like other adults with chronic conditions, should consult their health-care providers to match their physical activity plan to their abilities and health status.