When You Can’t Follow the Standard Plan

When You Can’t Follow the Standard Plan

Medical Disclaimer: This article is educational and is not medical advice, diagnosis, or treatment. It draws on current medical literature and clinical guidelines, but it cannot account for your specific diagnosis, medications, pregnancy, or circumstances. Always consult your own qualified healthcare providers before starting or changing how you exercise, and never delay or disregard medical care because of something you read here.

Stop exercising and seek care for warning signs such as chest pain or pressure, severe or unexpected breathlessness, fainting or near-fainting, or a racing or irregular heartbeat with symptoms. If a symptom is severe, comes on suddenly, or does not ease within a few minutes of rest, call 911 or your local emergency number. The population-specific warning signs in this article are in addition to this rule, not a replacement for it.

Any specific numbers here (minutes per week, example timelines, or intensity ranges) reflect patterns commonly used in guidelines, rehabilitation programs, or clinical trials, not a personalized prescription. Your own clinicians’ advice always takes priority.

In Brief: Standard guidance, about 150 to 300 minutes of moderate activity per week, assumes a fairly standard life: stable health, predictable time, a safe place to move, and the capacity to start with a brisk walk.[1] Most adults do not meet it, and the reason is usually a real constraint rather than a lack of effort. The large dose-response studies are reassuring here: the steepest drop in cardiovascular and mortality risk comes from moving off zero, with each additional minute mattering less than the first ones did; the largest gains come from moving from inactive to doing some regular activity.[4] This article does not lower that 150–300-minute destination; it changes the path and the timeline to fit deconditioning, complex medication regimens, unsafe or unaffordable environments, shift work, depression and anxiety, pregnancy, caregiving, and joint pain. The goal is not to exercise perfectly, but to find the safest, most sustainable movement available within your current constraints, built with your clinicians, not against them.

The standard plan is a route, not the destination

The number most people remember, 150 to 300 minutes a week, is the destination, and it is well supported.[1] But the usual route to it assumes things many people do not have. If you have been told to “just start with a ten-minute walk” and that advice felt detached from your reality, the problem is the route, not you.

Two facts make the detour worth taking. First, the benefit curve is steepest at the beginning: the jump from no regular activity to some is the largest single improvement available, and the curve flattens as volume rises.[4] Second, short sessions count: total weekly activity matters more than the length of any one bout, and bouts under ten minutes still contribute when they add up.[5] Together these mean a small, repeatable amount of movement is not a consolation prize. It is where most of the protection comes from.

The barriers in this article (deconditioning, many medications, unsafe surroundings, shift work, depression, pregnancy, caregiving, chronic pain) are real, with measurable physiological consequences. Naming them is not making excuses; it is the first step in choosing an approach that survives contact with your actual life.

It helps to be clear about what that movement protects. Regular activity preserves cardiorespiratory fitness, muscle mass, insulin sensitivity, balance, and mobility, the machinery behind everyday tasks and independence. Article 1 covers how exercise produces those changes in the heart and blood vessels; the point here is that they are what a barrier puts at risk when it keeps you at zero, and that even small, regular doses begin to protect them.

Find your main barrier

Work in three steps. First, name the single biggest thing standing between you and regular movement: pain, time, mood, medications, safety, fatigue, or capacity. Second, find it in the table below. Third, build the smallest realistic experiment for the next seven days, not a plan for life, just one week of something you can realistically sustain. Most people have more than one barrier; start with the one that limits you most right now, and look for strategies that solve several at once. Indoor short bouts, for instance, address deconditioning, time, safety, and joint load simultaneously.

This is a starting point, not a prescription. The detail for each barrier follows.

Gauging intensity without a heart-rate target

Heart rate is an unreliable guide through much of this article: irregular rhythms confuse it, and rate-lowering drugs hold it down. Article 3 covers the alternatives in full; the short version is to judge effort by how you feel and how you can talk. On a 0–10 scale of perceived exertion (RPE), light is 2–3 (you can speak in full sentences or sing), moderate is 4–6(breathing harder, able to speak in short sentences but not sing), and vigorous is 7–8 (only a few words at a time). For most adults, RPE 4–6 is where the bulk of cardiovascular protection comes from. Higher intensity adds benefit for some people, but it is not required for major risk reduction.

Warning signs that override everything

Whatever your barrier, stop and arrange medical evaluation for any of the following before continuing.

Heart-related: chest pain, pressure, or tightness with activity; breathlessness out of proportion to the effort; near-fainting, fainting, or sudden dizziness; an irregular, racing, or sustained palpitation; new leg swelling; or waking at night unable to breathe lying flat. Joint-related: a joint giving way, locking, or suddenly unable to bear weight; visible deformity, or a joint that is swollen, red, and hot; or fever with joint pain. Fatigue-related: exhaustion that worsens despite going easy, lasts for hours after light activity, or brings new symptoms at rest. Mental-health-related: thoughts of harming yourself, a loss of contact with reality, or an inability to manage basic self-care.

When in doubt, get evaluated first and resume with clearance. These override all other advice in this article.

Severe deconditioning

When you are deeply deconditioned, position and duration matter more than intensity. A meaningful “session” may be two or three minutes, repeated through the day. Typical patterns after prolonged illness, bedrest, major surgery, or advanced age with inactivity include breathlessness after less than about 200 meters of level walking, needing to stop within one to five minutes, or needing to sit down after a shower and rest partway up a single flight of stairs. Even short hospital admissions can produce lasting drops in functional independence when no structured rebuilding follows.[2]

This happens because inactivity changes several systems at once: blood volume and the heart’s pumping capacity fall (so you feel dizzier on standing), endurance muscle fibers shrink and use oxygen less efficiently, and the nervous system’s resting “stress tone” rises. The system becomes efficient at rest but poor at responding to demand, so small efforts feel disproportionately hard, which discourages movement and deepens the decline. The encouraging part is that the loop runs both ways: even three to five minutes of light activity, repeated across the day, measurably improves strength, walking speed, and daily function over four to eight weeks, and structured strength work with adequate nutrition produces real gains even in people in their 80s and 90s.[3] The body is deconditioned, not untrainable.

Start where you can finish the planned time at RPE 2–3, light, not hard. Your first goal is tolerating the duration, not pushing the effort.

Begin in positions that reduce dizziness and fall risk, then work upward: seated marching, heel raises, and arm circles; a seated pedal exerciser; standing supported by a counter, walker, or rail; recumbent cycling; or, if available and safe, walking in chest-deep water. Many rehabilitation programs start seated or recumbent and progress to upright walking as standing tolerance improves.

Progress in order: consolidate before you advance. First build frequency at low duration (say, three sessions of three minutes). Then combine into fewer, longer bouts (two of six, then one of twelve). Only then nudge intensity toward RPE 4–5. Watch your recovery as your guide: if a session leaves you wiped out into the next day, the dose was too high; drop back to the previous level and progress more slowly. Moving from severe deconditioning to thirty continuous minutes of moderate walking often takes three to six months, and longer after a prolonged ICU stay or bedrest. That timeline reflects safe biology, not failure.

One caution: do not assume “just deconditioning” if you have chest discomfort or breathlessness with minimal effort, palpitations or near-fainting, rapidly worsening fatigue despite going easy, or new leg swelling or breathlessness lying flat. Those patterns need evaluation; you may be undertrained, undertreated, or both, and only your team can tell which.

Complex medication regimens

When you take several cardiac or metabolic medications, how you monitor and time exercise has to change, and symptom- and RPE-based monitoring beats generic heart-rate formulas. Some clinicians use a rough flag: three or more cardiac drugs (beta-blockers, calcium channel blockers, diuretics, rhythm drugs) or eight or more medications total is a reasonable trigger for individualized guidance. The point is not the count but the interactions.

These are patterns to discuss with your clinicians, not instructions, and you should not change cardiac medications on your own. And if activity consistently provokes chest discomfort that needs nitroglycerin, treat that as a signal to review the exercise plan and your medical status with your team rather than to push through; Article 10 covers exercising with coronary disease in depth. Timing can help: many people tolerate activity better once the main diuretic effect has passed, and exercising away from a sedating dose feels easier. When first pairing exercise with insulin or a sulfonylurea, many programs suggest checking glucose before and after for a week or two to learn your own pattern. Bring a full medication list, with dosing times, to any exercise-planning visit; small timing changes sometimes make exercise far more workable. A few combinations (a beta-blocker with diltiazem or verapamil, several QT-prolonging drugs together, or layered blood thinners with fall risk) deserve extra caution, and for these an initial block of supervised cardiac rehabilitation is often the safest way to learn how your body responds.

A note on medication-induced weight gain: several cardiac and psychiatric drugs (some beta-blockers and antidepressants, antipsychotics, insulin, steroids) cause weight gain through real physiological effects, not failed willpower. That can stack secondary barriers like sorer joints or breathlessness at lower effort. The same principles apply: start where you are, use low-impact modes if joints are stressed, and match movement to your current body rather than a previous one.

Practical barriers: no space, no time, no money

Cardiovascular benefit does not require a gym, good weather, or expensive equipment; it requires regular moderate effort, and the setting is negotiable. Many neighborhoods lack sidewalks; many jobs allow no breaks; many households cannot afford memberships or childcare. These are circumstances, not character.

No safe or practical place outside. When streets are unsafe, unlit during your free hours, or the air or weather is hostile, move indoors: walking loops through your home or hallway; stair climbing with the railing; marching in place during television, calls, or podcasts; simple bodyweight circuits (chair squats, wall push-ups, step-ups, heel raises); or walking in large indoor spaces such as malls or big-box stores where allowed. Low-cost additions include resistance bands with a door anchor and a compact stepper. Many malls and community centers open early for indoor walking groups, which solve safety, climate, restrooms, and company at once.

Limited time. Because total weekly activity matters more than session length, and short bouts count, a fragmented day works: ten minutes in the morning, ten at midday, ten in the evening yields thirty minutes in manageable pieces rather than one block.[5] Strength circuits with little rest can cover both cardiovascular and muscle work when time is tight.

Limited money. Effective training can cost nothing: walking, stair climbing, bodyweight strength, and free online videos. If a small budget exists, the highest-yield purchases are a resistance-band kit, supportive walking shoes, and a basic mat. Many older adults qualify for insurance-supported gym access, and many cities run low-cost recreation centers.

An unsupportive household. Sometimes the obstacle is closer to home: a dismissive partner, no help with childcare, a culture that treats exercise as frivolous. Protocols help less here, but a few patterns do: choose exercise that does not require leaving (less to negotiate), exercise that doubles as family time (walking with children, active play), and early or late windows that do not compete with household demands. You may not be able to change the household; you can often work around it.

Shift work and rotating schedules

Shift work independently raises cardiovascular risk, so exercise here is layered on top of sleep protection, not used to replace it. In large cohorts of nurses, longer durations of rotating night-shift work were associated with a modestly higher risk of coronary heart disease that rose with years worked, roughly 12% higher after fewer than five years and about 27% higher after a decade or more, through disrupted day-night regulation of blood pressure, insulin resistance, chronic sleep restriction, and altered eating patterns.[6] Reassuringly, the risk falls again after people stop rotating nights. Exercise helps offset part of this risk, but it does not fully cancel the cardiovascular effects of chronic circadian disruption, which is one reason protecting sleep matters as much as the training itself.

Two principles make activity workable. First, anchor to your wake time, not the clock. Occupational programs often suggest moving within two to four hours of waking, whatever the hour. Second, protect sleep first. Short sleep, under about six hours, is itself linked to higher cardiovascular risk, so on days you are below that, restoring sleep usually takes priority over squeezing in a session; once you are reliably at six to seven-plus hours, adding 20–40 minutes of moderate activity adds protection rather than harm.[7]

A realistic week tends to split by day type. On work days, aim for one short bout (10–20 minutes) within a few hours of waking, or use a safe indoor break mid-shift to break up sitting. On off days, do the longer or more structured session. Across the week, even 60–90 minutes is far better than zero, since the step off inactivity is the largest gain, and you build toward the 150-minute target as sleep allows. After roughly 18–20 hours awake, balance and reaction time fade, so on the most depleted days favor low-coordination options (indoor walking, stationary cycling, simple bodyweight circuits) or skip the session and restore sleep, then restart less depleted. Because shift work and sleep loss compound the problem, Article 5 on recovery and sleep is worth reading alongside this.

Depression and anxiety

Depression and anxiety both raise cardiovascular risk and block the very behavior that would lower it; depression is linked to more heart disease and worse outcomes after cardiac events.[8] The treatment value of exercise here is well established: across high-quality reviews, regular activity produces medium reductions in depressive and anxiety symptoms, in the range seen with psychotherapy or medication for mild-to-moderate depression.[9,10] Aerobic exercise, resistance training, and mixed programs all help, typically at light-to-moderate intensity, a few sessions per week; what is best studied is simply regular, repeated movement rather than any single mode. As with cardiac medication, exercise works alongside therapy and medication, not in place of them; if you are being treated for depression or anxiety, add movement to that treatment, and do not stop a prescribed medication on your own.

The hard part is initiation: turning “I should” into “I am.” Telling someone in a depressive episode to take a thirty-minute walk often fails because the first step is too large. A behavioral-activation approach shrinks it: today’s whole commitment is to put on shoes and exercise clothes; if a two-minute walk follows, that is a bonus. Repeating tiny, completed commitments rebuilds the sense that starting is possible, even while mood is low. Reducing decisions helps too: a fixed time, the same short routine, and clothes set out the night before each remove a choice and free energy for the movement itself.

Anxiety adds two specific wrinkles. Exercise raises heart rate, breathing, and sweating, which can mimic panic; starting at RPE 2–3 and naming the sensations plainly (“my heart is faster because I’m walking”) makes the early sessions tolerable, with very gradual progression. And when gyms or crowds feel overwhelming, home-based work, quiet early walks, or small structured classes are easier entry points than a busy gym.

One boundary matters. If you are having thoughts of harming yourself, experiencing a loss of contact with reality, severe eating-disorder symptoms, or an inability to manage basic self-care, that needs urgent attention before exercise; contact your clinician, a crisis line (such as 988 in the US), or emergency services. Exercise can be added later, once acute risk is addressed and ideally with your mental-health team’s guidance.

Pregnancy

In uncomplicated pregnancies, regular moderate exercise is generally beneficial for both the pregnant person and the baby, but intensity, position, and activity type call for trimester-aware adjustments and obstetric input.[11,12] Normal pregnancy raises blood volume and cardiac output substantially, lifts resting heart rate, loosens ligaments, and shifts the center of gravity, all of which change how effort feels. Reviews and guidelines link regular moderate activity to lower rates of gestational diabetes, pregnancy-related high blood pressure and preeclampsia, and excessive weight gain, along with better mood, often shorter labor, and easier postpartum recovery; when appropriately prescribed, it does not raise rates of miscarriage, preterm birth, or low birth weight in uncomplicated pregnancies.[11,12,13]

Exercising flat on your back is generally avoided after about 20 weeks, since it can compress major veins and reduce blood return in some people. High-risk conditions (certain heart diseases, placenta previa after 26 weeks, preeclampsia, a high risk of preterm labor, and others) call for individualized plans and often avoidance of unsupervised exercise; the obstetric team is the final authority.

Stop exercising and contact your obstetric provider for vaginal bleeding, fluid leaking from the vagina, regular painful contractions, shortness of breath before exertion, chest pain, dizziness or a headache that does not resolve with rest, calf pain or swelling, muscle weakness affecting balance, or decreased fetal movement.[12] These are the standard warning signs and they take precedence over any activity goal.

Where you start matters: people who were highly active before pregnancy can often continue modified versions of their activities, while those beginning from a sedentary baseline usually progress more gradually. By trimester, the limits shift. In the first, nausea and fatigue usually constrain activity more than physiology does, and maintaining a reduced routine is a reasonable goal. The second is often the best-feeling phase, allowing steady moderate activity with a wider stance for balance. The third typically shifts from progression toward maintenance and comfort: shorter walks, more water-based activity, gentler strength work. After a vaginal delivery, light walking is often encouraged within days as tolerated, with a gradual return over weeks. After a cesarean, treat recovery like abdominal surgery: early walking yes, but heavier lifting and intense core work generally wait for the postpartum check and explicit clearance. Pelvic-floor symptoms (leakage, heaviness, pain) are common and treatable, and pelvic-floor physical therapy can be central to rebuilding confident movement.

Caregiving

Caregiver strain is linked to worse physical health, including higher cardiovascular risk and mortality, through chronic stress, disrupted sleep, less time for one’s own care, and higher rates of depression and anxiety.[14] Lower exercise minutes in this situation reflect the structure of the days, not a lack of will, so micro-doses and opportunistic movement are rational strategies rather than concessions.

In practice, a caregiver’s week is built from fragments and presence. Caregiver-present options include marching or walking in place while supervising, a short circuit or a few flights of stairs while food cooks, resistance-band work beside the chair, marching through television commercial breaks, short home circuits while the care recipient naps or watches television, and walking with a mobile care recipient (a stroller, a slow walk with an older relative). A workable pattern might be five to ten minutes on waking, a ten-minute walk during an appointment or a nap, and a short bodyweight circuit later, whether three ten-minute or six five-minute pieces that accumulate toward 60–150 minutes across the week. Even at the low end of that range, you are capturing most of the zero-to-some benefit.[4] Many caregivers feel guilty taking fifteen minutes for themselves; framed accurately, that movement is part of what keeps you able to keep showing up, not time stolen from the person you care for.

Joint pain

Joint pain is common, legitimate, and often accompanied by fear: of doing damage, of paying for it tomorrow, of advice that ignores how much it hurts. For some people, past attempts really did cause flares, so the caution is earned. But the evidence is consistent: appropriately dosed exercise (the right mode, at the right intensity, progressed at the right pace) improves pain and function in osteoarthritis without accelerating structural damage, and the long-term risk to joints is usually higher from never moving them than from moving them carefully.[15,16] The operative phrase is appropriately dosed; the generic advice you were probably given was not.

One distinction matters: this osteoarthritis logic does not map directly onto inflammatory arthritis such as rheumatoid or psoriatic disease. Gentle activity helps there too between flares, but during a flare, when joints are hot and swollen, exercise should be eased back and coordinated with the rheumatology team rather than pushed through.

It helps to tell ordinary soreness from a warning. Training soreness is a dull, fairly symmetric muscle ache that peaks a day or two after harder activity, eases with gentle movement, and does not change how you walk. Joint pain that calls for modification is focused and sharp or throbbing in or around the joint, worsens if you continue, changes your gait, or brings swelling or warmth afterward. Pain that needs prompt evaluation is sudden and severe, with the joint giving way or locking, visible deformity or marked swelling, or fever.

Choose the mode by the joint. For knees and hips, water walking and swimming, cycling or recumbent cycling, and the elliptical are joint-friendly; walking is fine with a slower pace, shorter stride, flat routes early on, and a cane or poles when recommended. For the low back, walking with neutral posture, recumbent cycling or water work, and lying-down core work prescribed by a therapist tend to be better tolerated than deep bending, twisting, or heavy overhead loads early on.

A practical way to build is to progress from less weight-bearing toward more as pain and confidence allow: for example, pool or water work first, then a stationary or recumbent bike, then the elliptical, then walking. Increase only one variable at a time (duration, frequency, or intensity), and when joints are symptomatic, a useful rule of thumb is to add no more than about 10% to total weekly volume per step. If pain worsens or lasts beyond a day after a session, cut back until it settles. Article 4 on strength training is a useful companion, since stronger muscles around a joint share its load.

Other conditions that blunt exercise tolerance

Two situations are worth naming because they are often mistaken for laziness or poor fitness. Iron deficiency and anemia (common after illness, heavy menstrual bleeding, the postpartum period, or surgery) can sharply blunt performance: feeling out of gas even at RPE 2–3, recovering poorly, getting worse despite consistent effort. Here clinicians usually check blood counts and iron rather than advising you to try harder, and correcting the deficiency often restores a more normal training response over weeks to months. Autonomic dysfunction (such as POTS) affects how the nervous system controls heart rate and blood pressure, producing a marked heart-rate spike on standing, dizziness, brain fog, and poor tolerance of upright exercise early on; specialized programs often begin with recumbent or semi-recumbent work and short intervals, with compression garments and generous fluids and salt when not contraindicated. Both situations usually need individualized guidance: from your clinician for anemia, and from cardiology or an autonomic specialist for dysautonomia.

A monthly check: proceed, modify, or call

Once a month, step back and sort each area into one column. If you are too tired to read the whole table, two questions carry most of the weight: are my symptoms safe, and am I recovering within a day? If both are yes, you can usually keep going as you are.

Mostly proceed: continue, and consider nudging one variable: duration, frequency, or intensity. Several modify: adjust the plan (smaller pieces, different timing, another mode) and reassess in two to four weeks. Any contact: pause progression and talk with your clinician, and bring your log, which is useful data. Returning after a break follows the same logic in reverse: after about a week off, restart near 80% of your previous volume; after two weeks or more, nearer 60–70%, then rebuild over a week or two.

Common Assumptions, Measured Against the Evidence

The Bottom Line

The 150-to-300-minute target is the destination, and it is worth keeping in view.[1] But the route there is negotiable, and the math favors starting small: the biggest jump in protection is the one from nothing to something, and short, repeated bouts capture most of it.[4,5] You do not need a gym, a free hour, or a perfect schedule. You need a form of movement your real life allows, done often enough to repeat. Match the dose to your constraints and to your clinicians’ advice, watch your recovery rather than the clock, and let the plan grow as your circumstances do. What you are protecting is not a number on a chart but your heart and blood vessels, your strength, and your independence: the capacity to keep doing what your life asks of you. The smallest plan you will keep to protects that more than the ideal one you never start.

What Comes Next

Article 12: Staying Active for Life turns from starting under constraints to sustaining movement over decades: which health markers beyond weight matter most, how to keep going through life’s disruptions, and how to build an exercise habit that survives them.

Key Terms

RPE (rating of perceived exertion): a 0–10 self-rating of how hard exercise feels; moderate effort is about 4–6.

Talk test: using speech to gauge intensity: full sentences at light effort, short sentences at moderate, only a few words when vigorous.

Behavioral activation: a depression strategy of starting with very small, defined actions to rebuild momentum and the sense that tasks can be completed.

Hospital-associated deconditioning: the loss of strength, fitness, and function that can follow even short periods of illness and bedrest.

Micro-bouts: short sessions, often under ten minutes, that contribute to weekly activity totals when accumulated.

Autonomic dysfunction (e.g., POTS): impaired automatic control of heart rate and blood pressure, causing dizziness and poor tolerance of upright exercise.

References

1. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd ed. Washington, DC: HHS; 2018.
2. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003;51(4):451-458.
3. Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330(25):1769-1775.
4. Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ.2019;366:l4570.
5. Jakicic JM, Kraus WE, Powell KE, et al. Association between bout duration of physical activity and health outcomes: a systematic review. Med Sci Sports Exerc. 2019;51(6):1213-1219.
6. Vetter C, Devore EE, Wegrzyn LR, et al. Association between rotating night shift work and risk of coronary heart disease among women. JAMA. 2016;315(16):1726-1734.
7. Cappuccio FP, Cooper D, D’Elia L, Strazzullo P, Miller MA. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J. 2011;32(12):1484-1492.
8. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146,538 participants in 54 observational studies. Eur Heart J.2006;27(23):2763-2774.
9. Singh B, Olds T, Curtis R, et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med. 2023;57(18):1203-1209.
10. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42-51.
11. Mottola MF, Davenport MH, Ruchat S-M, et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med. 2018;52(21):1339-1346.
12. American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 804. Obstet Gynecol. 2020;135(4):e178-e188.
13. Davenport MH, Ruchat S-M, Poitras VJ, et al. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med.2018;52(21):1367-1375.
14. Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one’s physical health? A meta-analysis. Psychol Bull.2003;129(6):946-972.
15. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:CD004376.
16. Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;3:CD005523.

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