PURPOSE: This study investigated the effects of a combined aerobic and resistance exercise program on maternal health and birth outcomes in pregnant people with obesity and prior sedentary lifestyle. METHODS: Two hundred and sixty-four pregnant people (>= 30.0 kg/m2) were randomly allocated to a standard-of-care group (SOC; n = 107) or an exercise group (EX; n = 157). The intervention consisted of aerobic, resistance, and stretching exercises, 3x per week from the 12 weeks of gestation until delivery. A submaximal cardiopulmonary exercise treadmill test was performed at 12 and 24 weeks of pregnancy. Biological sample collection, body composition assessment, resting and activity energy expenditure assessment, and depression and stress evaluations were obtained at 12.1 +/- 0.5, 24.2 +/- 0.7, and 36.0 +/- 0.5 weeks of gestation. Linear mixed-effect models were used to compare maternal outcomes, while linear and logistic models were used to compare delivery outcomes. RESULTS: The median compliance for exercise sessions attended from the start of exercise (14.0 +/- 0.8 weeks gestation) to delivery (38.8 +/- 1.7 weeks gestation) was 61.7%. No significant time x group interactions were found for most maternal outcomes, however, significant time x group interactions were observed in cardiorespiratory fitness outcomes, specifically in grade (p < 0.001), HR (p = 0.003), workload (p < 0.001), VO2 (p < 0.001) during final fitness testing stage corresponding to rating of perceived exertion of 15, and oxygen uptake efficiency slope (p < 0.001). No significant effects were observed for other maternal health outcome measures, including gestational weight gain, systemic inflammation, and birth outcomes. CONCLUSIONS: Regular physical activity and participation in aerobic and resistance exercise during pregnancy is safe and effective for improving and maintaining physical fitness and activity levels people with obesity who were previously sedentary.

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