There is still no exercise prescription for pregnancy hypertension — 13 studies in 17 years

Prenatal physical activity is broadly recommended in uncomplicated pregnancies. The open question is whether that recommendation carries over to women at high risk of, or already diagnosed with, a hypertensive disorder of pregnancy (HDP). This scoping review's answer is uncomfortable but honest: there is not yet enough research to answer it.

Following PRISMA-ScR, the review searched four databases — PubMed, Embase, Web of Science and the Cochrane Library — plus two trial registries, the WHO ICTRP and ClinicalTrials.gov, from inception to 19 December 2025. Two reviewers screened independently. What survived was 13 articles published between 2008 and 2025: 13 studies across 17 years.

What the 13 studies covered

The included work splits into two clinical contexts: women at high risk of HDP and women with established HDP. The interventions themselves ranged widely — aerobic exercise, resistance training, combined aerobic and resistance exercise, stretching and yoga.

The direction of the results was broadly positive. Most studies reported that structured exercise interventions may improve blood pressure control, reduce the risk of certain HDP-related events, and improve pregnancy and neonatal outcomes, endothelial function and maternal psychological well-being.

So why is there no prescription?

The problem the review identifies is not the results but the precision of the reporting. Heterogeneity in prescription parameters was substantial, and in particular the definition, classification and monitoring of exercise intensity were insufficiently operationalised across studies. If you cannot tell how intensity was defined, you cannot transfer the result to anyone else.

Safety reporting was weaker still. Safety monitoring, exercise termination criteria, adherence and intervention fidelity were inadequately reported — meaning these studies largely did not record what counted as a warning sign or what made them stop a session. In a high-risk population that is a serious gap. Some studies also used statistical methods that did not fully account for their pre-post or repeated-measures designs.

How this differs from uncomplicated pregnancy

Keep the two separate. What resistance training did to gestational hypertension risk in pregnancies without complications rests on its own human evidence, covered in lifting during pregnancy. That is a story about prevention. This review is about what happens after risk is identified or a diagnosis is made, and the two evidence bases are not equivalent.

How much exercise lowers blood pressure in general adults rests on far more data — see the exercise dose for blood pressure. Transplanting those numbers into blood pressure management during pregnancy is exactly the move this review warns against.

What can be done now

Thin evidence is not the same as ‘do nothing’. Most of the 13 studies reported a favourable direction, and the interventions included low-load options such as stretching and yoga. The practical instruction is narrower: translating that direction into your own intensity and exercise selection is a job for your doctor, not for a paper.

One note on records. The gap this review names — how intensity was defined and when sessions were stopped — is the same gap that opens up in personal logs. If you and your doctor decide to keep training, log the date, the exercise, the load or intensity, and the days you stopped along with why. At the next appointment, that log is the evidence, not your recollection.